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Full text of "The American journal of psychiatry, 1910-11"

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THE 



AMERICAN 
JOURNAL OFINSANlTYy 



PUBLISHED UNDER THE AUSPICES OF 
THE AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION 

Editors 
Henry M. Hurd, M. D. G. Alder Blumer, M. D. 

Edward N. Brush, M. D. J. Montgomery Mosher, M. D. 

Charles K. Clarke, M. D. 



VOLUME LXVll 



'The care of the human mind is the most noble branch of medicine." — Grotius 



BALTIMORE ^X" 

THE JOHNS HOPKINS PRESS l^Aft*V^i 



1910-1911 



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Z^e £oxb (giaftimere (preee 

BALTIMORE, MD., U. 8. A. 



32,1 
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CONTENTS OF VOLUME LXVIl 



July, 1910. 

L The Scope of the Activities of the Alienist. William 

Francis Drewry i 

II. Scheme for a Standard Minimum Examination of Mental 
Cases for use in Hospitals for the Insane. William A. 
White 17 

III. The Importance of Complete Records of the Insane, and 

a few Remarks Concerning Chiefly the Preliminary 
Examination. W. W. Hawke 25 

IV. A Study of Association in Insanity. Grace Helen Kent 

and A. J. Rosanoff 37 

V. Milit.\ry Psychiatry. R. L. Richards 97 

VI. Alcoholic Amnesia and Automatism. Charlet W. Pilgrim. 109 

VII. A Study of the Dementia Pr-icox Group in the Light of 
Certain Cases Showing Anomalies or Scleroses in Par- 
ticular Brain-Regions. E. E. Southard 119 

VIII. Report of the Committee on Medical Expert Testimony 

OF the American Medico- Psychological Association 177 

IX. Notes and Comment: 

Dr. Page's Address. — Expert Testimony and the Report of 
the Committee of the American Medico- Psychological Asso- 
ciation on the Subject 187-190 

X. Book Reviews : 

Report of an Epidemic of Bacillary Dysentery at the Dan- 
vers State Hospital. (Boston: D. C. Heath & Co., 1909-) — 
Die Wassermannsche Serodiagnostik der Syphilis in Ihrer 
Anwendung auf die Psychiatric. Von Dr. Med. Felix Plaut. 
(Jena: Gustav Fischer, 1909.) — Seventeenth Annual Report 
of the State Charities Aid Association to the State Commis- 
sion in Lunacy, November i, 1908. (New York: United 
Charities Building.) — Expansion of Races. By Charles Ed- 
ward Woodruff. (New York: Rebman Company, 1909.) — 
Modern Clinical Medicine : Diseases of the Nervous System. 
Edited by Archibald Church. Authorized translation from 
" Die Deutsche Klinik." (New York and London: D.Apple- 



IV CONTENTS 

ton & Co., 1908.) — Eleventh Annual Report of the State 
Board of Insanity of the Commonwealth of Massachusetts. 
(Boston: Wright & Potter Printing Co., 1910.) — Traite In- 
ternational de Psychologie pathologique. Tome premier, 
Psychopathologie generale. (Paris: Felix Alcan, 1910.) — 
Reports from the Pathological Laboratory of the Lunacy 
Department of New South Wales, Vol. II, Part I. (Sidney: 
William Applegate Gullick, Government Printer. 1910.) — 
A Text-book of Mental Diseases. By Eugenio Tanzi, Pro- 
fessor of Psychiatry in Florence. Authorized Translation 
by W. Ford Robertson and T. C. Mackenzie. (London: 
Rebman, Limited, 1909.) — Collected Papers, 1909, Depart- 
ment of Neurology, Harvard University Medical School — 
Mortality Statistics, 1908, Ninth Annual Report. (Washing- 
ton : Government Printing Office, 1910.) 192-208 

XI. Abstracts and Extracts : 

Ueber Falle von Jugendirresein im Kindesalter. — Con- 
tribute alio studio dell' anatomia patologica della paralisi 
progressiva. — A Cystoscopic Study of the Cerebrospinal 
Fluid in General Paresis 209-212 

October, 1910. 
I. Suggestions on the Psychology of Superstition. F. B. 

Dresslar 213 

II. Methods of Dealing with the Criminal Insane — De- 
fects IN Present Methods and Suggested Remedies. 
Austin Flint 227 

III. The Ethical Aspects of Expert Testimony in Relation 

to the Plea of Insanity as a Defense to an Indict- 
ment for Crime. Carlos F. MacDonald 241 

IV. The Intermittent Forms of Dementia Precox. William 

Rush Dunton, Jr 257 

V. Simulated Foolishness in Hysteria. Ernest Jones 279 

VI. The Simulation of Hysteria. Tom A. Williams 287 

VII. Metabolism in Dementia Pr^ecox. Giacomo Pighini and 

Giuseppe Statuti 299 

VIII. A Study of Association in Insanity. Part II. Grace 

Helen Kent and A. I. Rosanoff 31" 

IX. Remarks, Largely Statistical, Regarding the Treatment 

of Alcohoucs. a. R. Moulton 39i 

X. Proceedings of Societies : 

American Medico- Psychological Association. Proceedings 
of the Sixty-Sixth Annual Meeting 397 



CONTENTS * 

XI. Notes and Comment: 

The American Medico- Psychological Association and its 
Journal.— Meeting of the British Medical Association.— An- 
nual Meeting of the French Alienists.— Festschrift to Dr. 

Charles W. Page 428-431 

XII. Obituary : 

Dr. Dwight R. Burrell 432 

XIII. Half- Yearly Summ.mjy 434-452 

XIV. Abstracts and Extracts : 

Dioxydiamidoarsenobenzol, or "6o6," Ehrlich's Newest 
Remedy for Syphilis.— The Treatment of Syphilis with Ehr- 
lich's Dioxydiamidoarsenobenzol.— Contribution a I'etude du 
syndrome confusionnel considere comme premier stade de la 
demence precoce.— The Psychology of the Consumptive.— 
Apropos of Catatonic States in the Degenerates.— The Treat- 
ment of General Paralysis through the Aid of Injections of 

Nucleic Acid 453-459 

XV. Appointments, Resignations, etc 460 

January, 1911. 

I. Cardio-genetic Psychoses. Report of Case with Autopsy. 

Henry A. Cotton and Frederick S. Hammond 467 

II. Degenerations of Intracellular Neurofibrils with Mil- 
iary Gliosis in Psychoses of the Senile Period. Albert 
M. Barrett S03 

III. The Prevalence and Psychology of Pellagra. /. W. Bab- 

cock 517 

IV. The Gynecological, Obstetrical and Surgical Aspects of 

Pellagra. A Preliminary Study. Eleanora B. Saunders. 541 

V. A Report of Two Cases of Pellagra. M. L. Perry 553 

VI. Report of a Case of Juvenile Paresis. Henry IV. Miller 

and Nicholas Achncarro 559 

VII. Documented Delirium. An Autopathogr.\phy. Clarence 

Farrar 57i 

VIII. A History of Institutional Care of the Insane in the 

United States and Canada. Henry M. Hurd 5^7 

IX. DiPLOcoccus in Acute Delirium. R. E. Wells 593 

X. A Plan for Indexing Cases in Hospitals for the Insane. 

William A. White and Francis M. Barnes, Jr 597 

XI. Notes and Comment: 

Death of William Pryor Letchworth.— Casualties, Fatal 
Injuries and Suicides in Hospitals for the Insane.— The 
Care of the Insane in China 605-610 



VI CONTENTS 

XII. Book Reviews : 

An Outline of Individual-Study. By G. E. Partridge (New 
York: Sturgis & Walton Co., igio). Sammlung Kleiner 
Shriften zur Neurosenlehre (A Collection of Short Papers 
on the Study of Neurosis). By Prof. Sigmund Freud. Sec- 
ond Series. (Leipzig und Wien, Verlag Franz Deuticke, 

1909.) 611-613 

XIII. Abstracts and Extracts : 

Las hallucinations dans les delires toxiques. — Tabetiques 
et paralytiques generaux conjugaux et familiaux. — Paralysie 
generale et tabo-paralysie conjugale dans le department du 
Nord (1871-1900). — Troubles mentaux dans les maladies du 
coeur. — Occupation as a Therapeutic Agent in Insanity. . .614-618 

April, 191 i. 

I. Suggestions toward a Logical Classification of Mental 

Disorders, fared S. Moore 619 

II. What Can be done for the Prevention of Insanity by the 
Tre.\tment of Incipient Cases in General Hospitals, 
and What has been done in the Past. L. Vernon 
Briggs $37 

III. Cyclothemia — The Mild Form of Manic-Depressive Psy- 

choses and the Manic-Depressive Constitution. Smith 
Ely Jetliffe 661 

IV. Insanity among Adolescent Criminals. Charles H. North. 677 

V. Immunity in Relation to Psychiatry. John G. Fitzgerald. 687 

VI. Clinical Study of the Psychic Factors Concerned in 

Functional Psychoses. Charles F. Read 705 

VII. The Gross and Histologic Findings in Dementia Paretica. 

N, S. Yawger 725 

VIII. A Study of the Cerebro-Spinal Fluid. Oliver P. Bigelow. 745 
IX. Typhoid Fever in Hospit.\ls as Illustr.\ted at the New 

Jersey State Hospital at Trenton. F. S. Hammond. .. . 759 

X. A Clinical-Anatomical Classification of the Senile and 

Arteriosclerotic Disorders. Charles T. Lambert 769 

XI. Certain Disturbances of Thought. /. M. Keniston 775 

XII. Notes and Comment: 

Resignation of Dr. Hurd. — Resignation of Dr. Chapin. — 
Another Year's Treatment of Mental Diseases in the Albany 
Hospital. — Annual Meeting of the American Medico-Psycho- 
logical Association 783-790 



CONTENTS Vn 

XIII. Book Reviews : 

Des Fugues et Vagabondage. By A. JofFroy and S. Dupouy. 
(Paris: Felix Alcan, 1909.) 791-793 

XIV. Abstracts and Extracts : 

Psychotherapy — Its Uses and Abuses. — Mental Disturb- 
ances following Traumatism 794-796 

XV. Half- Yearly Summary 797-812 

XVI. Appointments, Resignations, etc 813-819 

XVII. Index 821 



Volume LXVII JULY, 1910 No. i 

AMERICAN 
JOURNAL OF INSANITY 

THE SCOPE OF THE ACTIVITIES OF THE ALIENIST.* 
By WILLIAM FRANCIS DREWRY, M. D., Petersburg, Va. 

By your preferment I have the honor of being your President 
for the term of a year. Though unworthy, I am grateful indeed 
to my friends who saw fit to confer upon me this badge of distinc- 
tion. I shall endeavor to acquit myself in a manner that may 
merit a fair degree of approval of even those whom Sheridan 
would call " my d — d good-natured friends." 

The selection of an appropriate subject for this address was, of 
course, my first cause of tribulation. I thought of telling of the 
brilliant achievements of our forefathers — their histor)- — but that 
had been done, time and again, by abler essayists, so, concluded I, 
what's the use of repeating 

" A little knowledge of the ways of men, 
A little reading of their deeds and fates, 
A little guessing at their thoughts and then 
A quick forgetting of their names and deeds — 
That's history." 

Next, it occurred to me that literature might perchance be a 

profitable theme — a review of the writings and opinions of some 
of the masters in psychiatry — 

" A little delving in the tomes they penned, 
A little conning of the verse they writ, 
A feeble grasping of their aims and trend, 
A shadow mem'rj' of their mirth and wit — 
That's literature." 

But soon I corrected the delusion that I could pen anything in 
this line of interest to you. 

* Presidential address delivered at the sixty-sixth annual meeting of the 
American Medico-Psychological Association, Washington, D. C, May 
3-6, 1 910. 



2 SCOPE OF ACTIVITIES OF THE ALIENIST [J"'y 

Then, something pertaining to science — that branch which ap- 
peals to us as its apostles— suggested itself, but could I fail to be 
discouraged by what the rhymer has said? — 

" A little daubing with a salt or two, 
A little mussing with a sticky mess, 
A few experiments half blundered through, 
A twilight testing of a groping guess — 
That's science." 

Lest I be charged with the exhibition of symptoms of log- 
orrhoea in getting ready to bear you the simple message I have, I 
waste no more time in platitudes and excuses ; but, without eflFort 
at well-turned phrases or rhetorical elegance, I shall make some 
rather rambling remarks on The Scope of the Activities of the 
Alienist. 

I shall not essay to do more than present in a cursory manner 
some of the important offices incumbent upon us who are actually 
engaged in hospital work, and upon those who are in sympathy 
with efforts in behalf of the insane. I cannot hope to say any- 
thing that is new. I do not belong in the class known as originals, 
except original sinners. I am only a dispenser, if you please, of 
the products of other men's brains. As no man, however, has a 
copyright, or mortgage, on all he thinks, I may at least be ex- 
onerated from the charge of literary piracy. If no less a person- 
age than the immortal bard of Avon could, with impunit)% borrow 
ideas, not words, from Boccaccio, surely a lesser light in the new 
science of psychiatry can, with propriety, be guided by the foot- 
prints of brilliant exemplars. 

A distinguished Southern surgeon used in his presidential ad- 
dress before a society of medical gentlemen this forceful language : 

Rigid self-inspection is the surest method of keeping sound, whether in 
theology or in medicine, and it can but be to our advantage to overhaul 
ourselves now and then and find out what we really are, what our motives 
and our purposes are, and what we are doing to attain the things we stand 
for. 

What does it mean to be a well-qualified alienist? He must be 
a well-rounded physician, a searcher after causes of mental dis- 
ease, a discriminating diagnostician and a clear-headed clinician, 
know and appreciate the difference in the workings of a normal 
and an abnormal mind, must be free from all taint of quackery, 



igio] WILLIAM FRANCIS DREWRY , 3 

charlatanry and fads, a good judge of human nature, and, like 
other good doctors, he should be altruistic. Particularly if he is 
the director or superintendent of an institution he must possess 
those qualities which a distinguished American, now much in the 
lime-light abroad, says are essential to good citizenship : " He 
must have those qualities which make for efficiency ; and he must 
also have those qualities which direct the efficiency into channels 
for the public good " — for the good of others, as well as for the 
advancement of science. 

The work before us, gentlemen, touches the humanities and the 
sciences at so many points that one is at a loss in selecting those 
matters for discussion which seem to be of the most vital im- 
portance. This Association has a definite purpose in that it has 
constituted itself the exponent of those broad principles which 
underlie a universal uplifting and healthfulness of the body and 
mind of members of the human race. Its chief aims are for an 
individual as well as a community cause. To be more explicit, it 
asks for the insane all the rights that are theirs as involuntary 
victims of disease and adverse circumstances, and for the people 
generally the protection that, in all fairness and justice, is their 
due. It also strives for a comprehensive understanding of the 
etiology, course, pathology and successful treatment of mental 
alienation. It does more. It tries, in a measure, to ascertain and 
point out the best and most rational way in which both the living 
and the yet unborn may be saved from brain disease and degener- 
acy, and a consequent life of suffering, dependence and un- 
happiness. 

Have we translated into full action the principles which we 
have boldly and persistently advocated? Looking backward one 
can but be impressed that it has been an upward struggle of 
heroic effort and much sacrifice to reach the present status in the 
humane care and treatment of the insane and to acquire a fair 
degree of knowledge of psychiatry. Betterment in all conditions 
which go toward helping to make possible the higher character of 
institutional life, with the view of curing, or at least improving 
the condition of, the brain-sick, has been, for many years past, one 
of the main objects of those engaged in this great field of human 
activity. It has been especially of note that in recent years the 



4 SCOPE OF ACTIVITIES OF THE ALIENIST [July 

scientific has been taking its proper place alongside of the humane 
part of institutional work. This harmonious union and corre- 
lation of essential elements of success can but produce in time 
eiTective results. Those of us who have long been in the hospital 
service can bear witness that the apathy which was formerly 
largely prevalent in our ranks is giving way to a livelier interest 
and an increased activity. The observant student of history can 
but be impressed that it is a far cry from the purely custodial 
asylum of former times to the hospital of to-day. 

Whatever may be attempted towards a purely high scientific 
standard, or however much we may insist upon grouping certain 
cases into " a clinical entity " or a " pathological entity " and 
labeling them with a distinctive name, we should not lose sight of 
the great fundamental importance of the purely practical side, 
embodied in kindly care, nursing and attention to the personal 
needs, comfort and happiness of the individual patients. Further- 
more, we must remember that without an efficient and concordant 
adjustment of the administrative, executive, nursing and medical 
machinery, little can be accomplished either for the benefit of the 
patients or to the credit of those who direct and control the policy 
of an institution. Briefly stated, there must be a thorough blend- 
ing and fusion of the scientific, the humane and the business 
factors. 

Speaking of the improved conditions in the institutional care of 
the insane, it seems to me that in at least one particular, some in 
this country still entertain ideas and follow a practice that are 
not in accord with the modern humane trend. I refer to the use 
of those obsolete measures known as mechanical restraints, solitary 
confinement, etc. It matters not what an institution has done in 
the way of putting itself in the front ranks in the field of research 
work, in architectural beauty, in dazzling equipments, or in the 
establishment of a training school for nurses, etc., it is not entirely 
in harmony with modern ideas, if it forces insane persons under 
its care and protection to submit to the application of such brutal- 
izing methods of control. Connolly, whose life was so crowded 
" with successful and generous labor for the advancement of 
science and its beneficent application to humanity," gave to the 
world an opinion about the non-restraint method which certainly 
is as applicable to-day as it was in his time. He said that such 



I9IO] WILLIAM FRANCIS DREWRY 5 

kindly measures "tended to remove as far as possible all causes 
of excitement from the irritable, to soothe, encourage and comfort 
the depressed, to repress the violent, by methods that leave no ill 
effect on the temper, no painful recollection in the memory. Hope 
takes the place of fear, serenity is substituted for discontent, and 
the mind is left in a condition favorable to every impression likely 
to call forth salutory efforts." 

Surely, with proper hydro-therapeutic means, a sufficient supply 
of trained and sympathetic attendants, quiet tact, discretion, at- 
tractive surroundings, a judicious application of psycho-therapy, 
employment and recreation, combined with rational medical and 
dietetic treatment, physical restraints and their like are not neces- 
sary to the proper management of an insane person who has 
lost his power of self-control. Experience of many years without 
restraint in any form and the minimum of confinement has fully 
satisfied me that they have no proper place in an institution for 
the insane. 

For the despondent states of the melancholic there is much in 
the beautiful yearnings of these lines of poor Percy Shelly: 

" Methiiiks there were a cure for these, with patience and care ; 
Twas perhaps an idle thought, 
But I imagined that, if day by day, 
I watched him and seldom went away, 
And studied all the beatings of his heart. 
With zeal as men study some stubborn art, 
For their own good, and could by patience find. 
An entrance to the caverns of his mind, 
I might reclaim him from his dark estate." 

It is well established that without proper classification of the 
acute, the chronic, the demented, the disturbed, the sick, the tuber- 
cular, the epileptic, the criminal and vicious, etc., it is impossible 
to carry into efifect those measures that are known to be of most 
value in caring for and treating these respective classes. Fortu- 
nately we have seen in recent years the growth at the more modern 
institutions, of the cottage or pavilion and the farm-colony plans, 
which afford facilities for a desirable differentiation. 

In successfully dealing with the acute, or recent and curable 
cases, work of the best quality is especially called for. Here 
should be the storm center, so to speak, of the medical and nursing 



6 SCOPE OF ACTIVITIES OF THE ALIENIST [Jl'ly 

activities of an institution. We see in several of the States signs 
which point to brighter prospects for the insane, in the way of 
observation or psychopatliic hospitals, or separate pavilions in 
connection with existing institutions. The better equipped and 
the more convenient are such departments for the prompt and effi- 
cient study and treatment of incipient cases, the better the results. 
To further enlarge the usefulness of a public institution there 
should be an out-door department to which threatening cases 
may go for examination, advice and treatment, in order that 
an impending attack may be averted. If every case of incipient 
insanity could have prompt scientific treatment, the crowds of 
chronic and incurable cases congregated in the hospitals would be 
decidedly smaller, and the cry for more room would seldom be 
heard. In the psychiatric hospital and clinic lies the greatest hope 
for the future. 

Another matter has not received the attention it deserves : The 
after-care of the insane, strange to say, has been practically passed 
by in all but a few States, notably New York. No forward move- 
ment can be complete without this feature, which is one of the 
most effectual prophylactic measures yet suggested. It should 
constitute an important feature of the public service. 

" Tis not enough to help the fallen up 
But to support him after." 

It will hardly be denied that, for one reason or other, there are 
also other conditions prevailing in many of our institutions and 
in our dealings with the insane, that do not approach the ideal, 
and probably never will until there is a more general professional 
and public awakening and a creation of a demand for higher 
standards everywhere. It is our duty then to continue to strive 
at every institution to put into operation whatever study and 
experience have proven to be most profitable. The modern spirit 
of advancement calls for the following: Larger means, better 
equipments, more and better qualified physicians and nurses, and 
sufficient compensation to justify their remaining in the service, 
elimination of politics and in lieu thereof the civil service or 
merit system in appointments, better means of classifying and 
separating the various types of patients, so that each may receive 
proper treatment and care, closer clinical study and more exact 



igio] WILLIAM FRANCIS DREWRY 7 

observation of the bodily symptoms and diseases of individual 
patients, and the mental disorders of the various physical condi- 
tions. In place of restraints, sedative or doping drugs, simply 
housing and feeding and clothing, and the like, there needs to be 
more systematic recreation, and suitable and healthful physi- 
cal and mental occupation. The medical treatment should be 
supplemented by surgical whenever the physical condition is of a 
nature to demand it. There should be maintained in every insti- 
tution a laboratory for physiological, chemical, pathological and 
bacteriological investigations, and a systematic study of the patient 
in both a physical and mental aspect. By this means we can learn 
much respecting the part bacterial toxins and morbid ferments 
have in the causation of the insanities. 

There are many things in our minds we want to do, many ques- 
tions to be answered that call for systematic and energetic study 
" under favorable conditions in a well-staffed and well-equipped 
hospital," as well as outside of institutions. To quote from an 
address by Dr. Edwin A. Alderman, the distinguished president 
of the University of Virginia : 

We are having many visions. Perhaps they are sometimes a little crude, 
perhaps we are occasionally hysterical in our visions, but it is a sublime 
sort of hysteria. Perhaps we sometimes think of too many things to do 
without staying long enough with the things we are already doing. We 
are busy with new problems, instead of coolly setting into eternal forms the 
concepts we are making. But we are learning. We will cool off some day 
and leave the next generation something to do. Each age has its dreams, 
which change with the mood of the centuries. 

Economy in the construction and administration of public hos- 
pitals should, of course, be required. Those who manage such 
institutions owe it to the taxpayers to guard against extravagance, 
but too often there is an enforced penury which cripples or de- 
stroys utility. A parsimonious policy is responsible for the retar- 
dation of many of our institutions and the blocking of much good 
scientific work. It is a little trying on our nerves to go to the 
legislature and face the many obstacles in the way of advance- 
ment, or have a deaf ear turned to us when we are trying to bring 
about desired and needed reforms, or advocating what is known 
to be for the best interest of both the insane and the State. 

The responsibility for the existence of causes of complaint and 



8 SCOPE OF ACTIVITIES OF THE ALIENIST [July 

of investigations of some of our institutions, must often rest upon 
tlie people who, as a general thing, give scant credit to those in 
charge for what they accomplish imder unfavorable conditions, 
but are ready to condemn them for failing to do what is impos- 
sible with the means allowed by the legislature. Yet primarily the 
reason we don't accomplish all we desire is largely to be laid at 
our door. We often stand back and do not pursue a progressive 
policy in our relation with the legislature. The advance move- 
ment must start with us. Each of us is a part of the machinery 
which brings about achievement of eflfective results or failure. 

True, in many instances the financial condition of the state does 
not admit of adopting a high standard of provision for the insane ; 
but, nevertheless, we should present our arguments as strongly as 
possible, and then rest the case with the powers that be. In the 
language of Dr. Isaac Ray, we should be bold enough to say to 
these representatives of the people : 

The insane within your borders require your aid ; you are bound bj' the 
great law of humanity and by every sense of obligation to give it, as 
cheaply as you can consistently with the perfect accomplishment of the 
object, but cheap or dear, it must be given to the utmost extent which the 
progress of improvement has shown to be possible. 

It is a regrettable fact that in practically every State the in- 
digent insane receive first care in a jail — a prison — where they 
are often totally neglected, harshly treated and shamefully abused. 
There is a moral obligation upon every State to see that no citizen, 
either during the critical and trying time when the question of his 
insanity is under consideration, or pending his transfer to a hos- 
pital, is subjected to any such degradation and neglect. 

We cannot repeat too frequently that the care and treatment of 
an insane person is no less a medical matter before than after he 
enters a hospital. Therefore, it should be a statutory requirement 
that the health officers, or some other authorized medical board 
or local medical officers, have preliminary control of all cases of 
alleged insanity until they are transferred to a proper institution. 
The neglect and abuse of the insane prior to commitment to a 
hospital are unquestionably the weakest points in our American 
system of dealing with these unfortunates. No one advanced step 
would be more far-reaching as a curative or a preventive measure 



igio] WILLIAM FRANCIS DREWRY 9 

tlian the abolition of the cell in jail or public station as a place of 
detention of the insane. Here again we see the need of psychiatric 
hospitals or special wards in general hospitals. 

I would suggest that this Association appoint a committee to 
ascertain the laws of commitment in the several States and to 
recommend whatever seems most in keeping with modern prog- 
ress and conception of insanity. Such a committee might also do 
some other profitable work by making abstracts and reporting to 
the Association, of all the important new laws in the various 
States, which have to do with the care and supervision of the 
insane or any change in systems of management. 

I would, furthermore, recommend that a strong committee be 
appointed to ascertain and report on the status of the medical and 
scientific work in the hospitals of the several States. If each of 
us knew more about what others were doing to advance psychiatry- 
there would be given an impetus to better work throughout the 
country. 

It cannot be too often nor too strongly emphasized that one of 
the greatest needs of the hour in advancing the cause of the in- 
sane, is the adding to the curriculum of every medical school an 
adequate course of systematic, didactic and clinical lectures in 
psychiatry, supplemented by a laboratory for experimental psy- 
chology. No up-to-date medical school can afford, in these times 
of advanced medical education, to be without its well-equipped 
chair of psychiatry, yet there are many that are not so equipped. 
Until this progressive step is taken this department of medicine 
must remain behind other specialties. It is a regrettable fact that, 
with few exceptions, the young medical graduates who are 
appointed to positions in the hospitals for the insane, have had 
little or no previous knowledge or training to fit them to intelli- 
gently diagnose or treat insanity. 

Nothing goes farther in giving the general public false concep- 
tions of insanity than the display of gross ignorance of many 
general practitioners. Frequently we are called in consultation to 
find an unfortunate brain-sick patient absolutely stupefied by 
opiates or other narcotics, or bound hand and foot, or otherwise 
improperly treated, simply because the physician had not had 
sufficient experience or instruction to qualify him to properly deal 
with cases of insanitv in the earlv stages. 



lO SCOPE OF ACTIVITIES OF THE ALIENIST [J"ly 

Furthermore, the average general practitioner often fails to 
recognize important mental symptoms until they have become 
chronic and probably incurable. When he becomes more familiar 
with mental diseases he will be a powerful factor not only in cur- 
ing cases in the early stages, but in the application of preventive 
measures. Through him more than through any other agency 
can the " exaggerated apprehension of danger and the common 
notion of insanity as a disgrace, to be concealed or put out of 
sight, rather than a disease to be soon and wisely dealt with," be 
allayed. 

To return to the young medical officer in the hospital — after he 
enters the service, he should be given every possible opportunity 
and incentive to pursue clinical and research work, instead of 
having practically his entire time taken up, as is usually the case 
in many of the institutions, with the daily routine ward-rounds 
oftentimes performed in a perfunctory manner. The really sci- 
entific study of the patients and their diseases cannot, under such 
conditions, receive the attention they deserve. The medical spirit 
needs more encouragement. The assistant physicians need to be 
more progressive and to have a broader conception of their field 
of activity. 

The British Medico-Psychological Association has recently 
taken up consideration of means of promoting a more efficient 
medical service and encouraging scientific study by requiring a 
post-graduate diploma in psychiatry. Whether our hospital physi- 
cians, including superintendents, procure special diplomas or not, 
they should be given, from time to time, an opportunity of becom- 
ing familiar with what is being done in the best institutions and 
medical centers, and otherwise encouraged to keep fresh the in- 
terest in their specialty and in medicine generally to prevent 
routine of thought, and to become familiar with the best methods 
of practice. 

There continue to be considerable criticism and comment in the 
lay as well as the medical press respecting expert testimony. It 
is especially the emplo}'ment of alleged unscrupulous experts to 
assist lawyers in establishing insanity as a plea to secure a verdict 
of acquittal in criminal cases, that is condemned. How much 
truth there is in the charge that frequently such experts have been 
employed to help defendant attorneys in the construction and in 



igiO] WILLIAM FRANCIS DREWRY II 

the conducting of cases so that somehow or other they fit in with 
some psychosis, and befuddle the jury, I do not know. At all 
events, dishonest experts when discovered should be promptly 
exposed and condemned by the medical profession. There should 
be a determination to discountenance any expert who is not 
guided, as far as can be ascertained, by a clear conscience, for 
after all, this, with competency, constitutes our tower of strength. 

Then again, sympathy for the accused, or prejudice against him, 
or the persuasive and plausible statement of a shrewd attorney, 
sometimes leads an expert of small mental caliber and less firm- 
ness, and maybe a flexible conscience, to give an opinion desired 
by, or in the interest of, one side or the other. He unconsciously, 
perhaps, becomes a partizan, which fact, of course, makes him 
incompetent as an impartial witness, and for that reason he should 
be excluded from the witness chair. He is to be pitied rather 
than condemned. 

Every right-thinking man is in sympathy with the man who 
defends the purity and sanctity of his home, or protects the good 
name of virtuous womanhood. The rights and protection of such 
a man should be amply safeguarded by law, and there should be 
no need of " proving him insane " as an excuse for doing what is 
sanctioned by the best elements of society. Even in these so-called 
unwritten law cases an alienist cannot be justified in prostituting 
the high science of medicine to supply what the law has failed to 
supply to give protection to the man whose cause is a just one. 

What is and what is not insanity, more especially when the 
question of responsibility for crime is involved, is a serious matter 
and cannot be settled except by the most profound and conscien- 
tious students of mental medicine. For this and other obvious 
reasons the partizan and dishonest witness should go under the 
scorn of a high-minded and honorable profession. That reforms 
are needed to meet the present state of medical advancement, 
to alleviate the strained relations between the professions of law 
and medicine concerning expert testimony, and to put forensic 
medicine upon a higher plane, no impartial or capable alienist, I 
believe, will deny. I trust then that this Association will put itself 
on record as advocating some feasible plan that will perhaps set 
at rest and put upon sure and high ground the attitude of Amer- 
ican psychiatry in this important phase of our work, that so deeply 



12 SCOPE OF ACTIVITIES OF THE ALIENIST [July 

concerns the public and the medical profession. I have no doubt 
that your able committee on expert testimony will offer most 
valuable suggestions. 

The highest object in any field of medicine, is prophylaxis. 
Preventive medicine is indeed the watchword of the times. It 
is then in this special field of professional and public service that 
the alienist should be aroused to a greater appreciation of his 
opportunities and of the influence he is capable of exercising for 
the common good. 

Believing that in inherited instability we have a most potent 
etiological factor in insanity, epilepsy and degeneracy, much has 
been written in recent years as to who should be parents. " What 
is bred in the bone will out in the flesh " is a truism that few have 
attempted to refute. Yet we know little about the complex subject 
of heredity. We should strive by systematic and prolonged inves- 
tigation to know more. For instance, how can it be explained 
satisfactorily that in a group of children with the same parentage, 
same environment, etc., one child will become insane, another an 
epileptic, another a degenerate or a criminal, and another develop 
into vigorous, intellectual and moral manhood ? We cannot under- 
stand, in the light of observation and experience, how so distin- 
guished a philosopher as Locke could support the strange theory 
that all persons came into the world with equal mental endow- 
ments, and that solely to education and training was due the de- 
velopment of the variation or difference in mental capacities. 

Restriction of the marriage of the unfit, prenuptial examination 
of the male, segregation, stei^ilization and other measures having 
as their objects the checking of ancestral weakness and disease, 
continue to be live topics in scientific and sociological circles, yet 
none of these have been received with very much popular favor. 
This is due mainly to indifference and ignorance regarding the 
terrible effects of a bad heredity. A few states, however, have 
taken an advanced stand. The whole subject is still open to dis- 
cussion and further suggestion on many interesting points, and it 
may be years before definite conclusions are reached. In the 
meantime it is especially incumbent upon psychiatrists to give 
most careful study, without prejudice, to every proposed rational 
means that gives any promise of improvement of the race by 
lessening the number of mental wrecks and degenerates that come 
into the world. 



igio] WILLIAM FRANCIS DREWRY I3 

With the purpose of checking the procreation of the offspring 
of confirmed criminals and certain defectives, several States have, 
as you know, enacted laws authorizing vasectomy. To be pro- 
ductive, however, of appreciable benefit, it would have to be ap- 
plied to all, or a large proportion of, confirmed criminals, habitual 
drunkards, and to defectives, such as epileptics, imbeciles, as well 
as to the chronic insane and to those manic-depressive cases who 
spend their time, during the intervals between attacks, away from 
the restraining influences of the hospital. There is certainly much 
that may be said in justification of even so radical a means of try- 
ing to protect succeeding generations. Of course whenever such 
measures are adopted there should be proper legal safe-guards 
and competent medical advice. 

Pertinent to this important subject. Dr. Albert G. Keller, 
Professor of the Science of Society, Yale University, has this to 
say, in part, concerning the " limits of eugenics " : 

What eugenists can do, in this " age of reason," is to combat the grosser 
manifestations of counter-selection or breeding from the unfit, through the 

means of legislation and education Sympathy for the unfortunate 

unfit should not extend to the granting of the right of procreation, by 
which the parental unfitness is perpetuated at the expense of the fit who, 
at the very least, are taxed to afford the relief given. Here, too, any 
hurried or radical enterprise (e. g., the abrupt enforcement of premarital 
physical examination) is sure to run afoul of the folkways (e. g., the 
sense of modesty). But there is yet another way to work for eugenics; 
and that is to e.xpand, so far as possible, the limits set for it by ignorance ; 
to invoke an actual fear of consequences. This is the province of the medi- 
cal man, who is in the position to know the dangers and to some extent 
to enforce what he knows on a number of people. Laws forbidding the 
most frequent cases of counter-selection (e. g., marriage of idiots) can 
be passed by the educated minority, and enforced by the machinery of the 
State on the ignorant or careless. There can be no grand overturning of 
what has existed time out of mind, but there can be a skillful elimination 
of certain gross extremes of man-breeding. 

Whatever innovations we may advocate in efforts at prophy- 
laxis, it cannot be too strongly urged that it is a part of our pro- 
fessional life to give practical advice and instruction to those who 
bear the responsibility of rearing and educating children, so that 
they may be competent to train the parents of the future to a reas- 
onable understanding and appreciation of the advantages of 
proper environment, good habits, self-control and the value of 



14 SCOPE OF ACTIVITIES OF THE ALIENIST [Juty 

physical and mental hygiene. This is the most important part of 
the new work of all earnest and patriotic physicians. 

As a close second to heredity, as a potent etiological factor in 
mental and nervous diseases and degeneracy, comes alcohol. 
Kraepelin says that over 33 per cent of insanity, idiocy and prosti- 
tution shows alcohol in parents. It is dien not only the inebriate 
himself, but his descendants, that have to be considered. How 
to stop inebriety and its baneful effects is yet an unsolved prob- 
lem. Prohibitionists see in the abolition of the saloon a remedy. 
Others view the situation entirely from a moral standpoint. 

Some say that since American people are going to drink whether 
or no, tlie government should place the strictest possible regula- 
tions on the quality, the age, etc., of alcoholic beverages before 
they are put upon the market. As long as the manufacture of 
ardent spirits is permitted we shall have to contend against the 
many-sided evils of intemperance. At all events, we, as physi- 
cians, have a duty to perform in suggesting the best and most 
practical method of dealing with the inebriate, who is such not 
always from his own choosing. He constitutes a public problem 
the solution of which will probably come, at least to a great ex- 
tent, through the medical profession and conservative social re- 
formers. 

The opinion that inebriety is due to psychic defect as well as 
moral delinquency is gaining ground, and that treatment to be 
effective must be based not upon emotional prejudice, but on 
scientific determinations of the nature of the defect, and the best 
methods of its correction. Therefore, it would seem that in 
special institutional treatment and proper legal control, confirmed 
drunkards, as well as drug habitues, have the greatest hope of 
relief and the best chance of restoration to useful and productive 
citizenship. 

In this paper I have time simply to mention that the people, 
particularly the younger, should be taught more of the far-reach- 
ing effect of certain so-called social diseases. It is not appreciated 
what terrible results to both body and mind follow such loathsome 
affections. A distinguished English alienist says : " If only the 
evils of alcohol and venereal diseases were disposed of, then half 
the problem of insanity would disappear with them." 



igio] WILLIAM FRANCIS DREWRY I5 

The eagerness with which the medical profession is being sup- 
ported in whatever it undertakes for the common good, should 
give encouragement to us to enlarge our scope of usefulness and 
to join other physicians and reformers in taking advantage of 
every opportunity to benefit our fellow creatures. Witness the 
anti-tuberculosis movement, which is continually gathering 
strength and becoming more and more effective in the conquest of 
that dread disease which has slayed its victims by the millions. 

The world owes to Dr. Trudeau, the pioneer in the modern 
effective methods of cure of tuberculosis, a debt of gratitude it 
can never pay. We observe, too, with what vigor the cancer 
problem is being studied, what efforts are being made to eradicate 
hookworm, and the investigations going on looking to an under- 
standing of the causes, treatment, etc., of pellagra. It is a signifi- 
cant sign of progress and public philanthropy that great institu- 
tions are established and maintained and great movements are 
promulgated through the beneficence of wealthy men, for the pur- 
pose of searching for means of preventing and curing disease, 
preserving and strengthening life and protecting it from its 
enemies. 

Were educational campaigns set on foot throughout this coun- 
try in respect to insanity, epilepsy and allied conditions, their 
prevention, causes and treatment, the effect would in time be far- 
reaching in its influence upon the physical and intellectual life 
of the entire nation. This educational movement should be con- 
ducted largely through the medical press, medical societies, popu- 
lar lectures and by the personal instruction by well-qualified 
specialists. 

We, my colleagues, should be skilled alienists and scientific 
physicians, but something more. We should be publicists as well. 
This country is looking to us, the general medical profession de- 
mands of us, and the mentally afflicted are appealing to us, to use 
every possible opportunity within the range of our high calling to 
advance science and to help the weak and the sick. Success or 
failure in the advance of psychiatry, and in preventing the con- 
tinued increase in insanity and in the cure of those already insane, 
will depend largely upon how each of us uses his opportunities 
and does his duty. To us much has been given, of us much is 
expected. 



l6 SCOPE OF ACTIVITIES OF THE ALIENIST [Ju^Y 

Let US emulate the life and works of such a man as Connolly, a 
man of " broad and generous sympathies with the world," ever 
active in " measures for the general improvement of the people," 
giving his time and influence for their purpose, " lending his 
effective pen to their support." We, like him, should be asso- 
ciated with the benevolent, the high-toned, the progressive, and 
those who believe in the onward march of civilization, and in their 
duty to contribute what they can to aid it. 

He who looks into the past and sees what progress has been 
made and contemplates the ever-broadening views of the present, 
must appreciate the great possibilities of the future. Indeed we 
have acquired a wider vision and there looms up a broader horizon. 
This generation is to be congratulated on the creative work it is 
doing. Never before has there been displayed more energy of a 
constructive nature than is found in almost every department of 
activity. 

The evolution in psychiatry has been of slow growth, neverthe- 
less, in view of the obstacles constantly in the way, this depart- 
ment of human endeavor has made creditable advance; but we 
need to go further— much further. Let the scope of our activities 
be such that we shall keep well abreast in the procession of pro- 
gressive medical science, philanthropy and national reforms, and 
in all things that have for their purpose health, happiness and 
usefulness of the people. 

Let each of us, ladies and gentlemen, strive earnestly and dili- 
gently to carry forward the work in hand, fully realizing this 
maxim of the Talmud : " The day is short and work is great— 
the reward is also great — and the master presses. It is not incum- 
bent on thee to complete the work, but thou must not therefore 
cease from it." 



SCHEME FOR A STANDARD MINIMUM EXAMINATION 

OF MENTAL CASES FOR USE IN HOSPITALS 

FOR THE INSANE. 

By WILLIAM A. WHITE, M. D., of Washington, D. C. 

In hospitals that admit large numbers of patients annually and 
in which the personnel of the medical staff is continually changing 
it becomes necessary to adopt some standard scheme of examina- 
tion of the patients for several reasons. Of the innumerable things 
that might be required in such an examination many have only 
occasional value and many, in the nature of the case, could not be 
required at all. It, therefore, becomes necessary in outlining any 
scheme for general application to have in view only a minimum 
requirement. In other words, so much at least shall be done in 
every case and as much more as the examiner desires or the neces- 
sities of the case indicate. 

A standard examination soon becomes familiar to all. In using it 
one is less likely to leave out essentials, as very often happens when 
the examination is conducted in a desultory way without any plan 
of procedure. Certain portions of the examination, as for example 
the stories, can merely be referred to by name and do not have to 
be repeated each time, such as the cowboy story, the good-girl 
story, etc. (See Table VII.) Every one knows these tests by 
heart and the response of the patient is all that needs to be re- 
corded. Then again the standard examination gives a better basis 
of comparison between different patients, particularly those suffer- 
ing from similar conditions. It is also a means of calibrating, so 
to speak, the individual patient at different periods of his malady. 
The same mental tests gone through with at different times give 
an excellent idea of whether the patient's condition is changing or 
not and indicate, too, something of the nature of the change. With 
a standard method it is much easier to initiate new men as they 
come on the staff. They find the scheme in full operation and soon 
fall into using it. This renders them highly valuable at a time 
when they would be comparatively useless if merely permitted to 



l8 STANDARD EXAMINATION OF MENTAL CASES [Julv 

drift and suit their own inclinations. This last reason is a par- 
ticularly strong one in hospitals for the insane, where the whole 
problem is so different from that in the general hospital. 

The principal value that a scheme of examination may have, 
however, is in formulating tests that call for an actual record of 
the patient's reaction and not the conclusion of the examiner. Our 
mental examinations are filled with such remarks as " the patient 
shows lack of judgment " or is " disoriented " or has " failure of 
memory." All of these are conclusions and by no means records of 
fact. Such histories are useless to any one except perhaps the 
person who wrote them. The reader of a history is entitled to a 
statement of the facts on which the conclusion is based and then 
he is at liberty to form his own conclusion from the identical prem- 
ises. How much better and more accurate than the statement " de- 
fective memory " would be this test : The patient in the course of 
the examination is given the address, 375 Oxford St. After five 
minutes he is asked to recall it. He gives the num.ber 176, but 
cannot give the name of the street at all. Here is a definite fact. 
A multiplicity of such facts gives any one a basis for conclusions 
about the patient. Of such statements should the record of an 
examination be composed. 

The following scheme, which is largely the work of the Scientific 
Director, Dr. S. I. Franz, is the one now in use in the Government 
Hospital for the Insane and is the result of a considerable amount 
of study and experience. Suggestions have been culled from all 
available sources in its construction with a view to making it as 
useful as possible. Although further experience will undoubtedly 
cause it to be modified from time to time, it has proven so valuable 
to us thus far that I am reproducing it here in the hope that it may 
be of use to others. 

The examination of a mental case should be carried out under 
several heads as follows : 
I. Family history. 
n. History of patient. 

HI. Present illness. 

IV. General observations. 
V. General physical examination. 

VI. Neurological examination. 
VII. Mental examination. 



I9IO] WILLIAM A. WHITE I9 

It is recommended, for hospitals for the insane, that the follow- 
ing tables be prepared in chart form and hung up in the examina- 
tion room : 

I. FAMILY HISTORY. 

Informant: (name, relationship to patient, address). 
Grandparents: Parents: (uncles and aunts), Sibungs: 
Children: (with abortions and miscarriages). 

In securing the family history it must be remembered that it is 
equally important to get a record of all the normal members of the 
family as well as the abnormal and not stop with securing the 
latter, as is often done. The patient's relation to hereditary ten- 
dencies can only be determined by securing information about his 
ancestors. For example, Heron ' has shown that the liability to 
insanity in children from insane stock is greatest among the earlier 
born and falls off rapidly, particularly after the fourth child. 

II. HISTORY OF PATIENT. 

Full Name : Address : Occupation : 

Birth : Childhood Diseases : Learned to Walk and Talk : 

Diseases: (especially convulsions, delirium, head-injury, gonorrhoea, syph- 
ilis, rheumatism, neuritis). 

Habits: (alcohol, drugs and sexual). 

Marriage : Menstruation : Gynecological : 

Previous Attacks: (special attention to so-called hysterical, to break- 
down, and to melancholic periods). 

Crimes and Misdemeanors: 

Mental Make-up: 

The history of the patient is especially important for getting a 
comprehensive idea of the sort of person the patient was before 
becoming insane. A given mental disorder cannot be fully under- 
stood without understanding, not only the circumstances that gave 
rise to it, but the other and more important factor, the make-up 
of the individual in whom the disorder occurs. 

III. Present Illness : 
Onset: Cause: Physical: Mental and Moral Changes : 
Emotional Condition : Hallucinations and Delusions : 
Judgment: Memory: Suicide and Homicide: Insight: 

Under this head is made an inquiry into all the circumstances 

' David Heron, M. A. : A First Study of the Statistics of Insanity and 
the Inheritance of the Insane Diathesis. Eugenics Laboratory Memoirs, 
II. University of London. 



20 STANDARD EXAMINATION OF MENTAL CASES [Ju'y 

surrounding and conditioning the onset of the psychosis and the 
patient's attitude toward them and his insight. He should be 
asked frankly whether he believes himself insane ; if not, how is it 
that he has been sent to a hospital for the insane ; what he may 
have done or said to lead others to think him insane ; what is his 
explanation of the whole situation and how it all came about. 

IV. GENERAL OBSERVATIONS : 
Faoal Expression : Appearance and Demeanor : Movements : 
Speech : Mental : 

The general observation of the patient is, of course, always im- 
portant: whether he appears silly, resentful, indifferent; whether 
he has mannerisms, etc. It is particularly important, however, in 
stuporous and delirious patients who either will not speak or are 
not responsive and, therefore, not accessible. These patients 
should be observed particularly as to their general attitude of body 
and limbs, the expression of the face, the reflexes, and the reactions 
— volitional, emotional, and organic (hunger, sexual, responding 
to calls of nature, etc.). 

V. GENERAL PHYSICAL EXAMINATION. 

Form : Nutrition : Weight : Height : Skin : Bones and Joints : 

Decubitus: Scars: (especially penis and mouth). 

Respiratory System : 

Circulatory System : Heart-position ; Size and Sounds ; Blood- 
Pressure : 

Genito-urinary System : 

Gastro-intestinal Tract: Stomach Content; (if indicated); Glands; 
Abdomen : 

Sputum: (if indicated). Blood Composition: (if indicated). 

Urine: (always). 

It is hardly necessary to insist upon the necessity for a thorough 

physical examination in every case. It is especially important in 

the deliria in which the mental disorder may be the expression of 

an obscure physical condition. 

VI. NEUROLOGICAL EXAMINATION. 
Atrophy : Hypertrophy : 
Movements, Voluntary: Activity; rapidity; accuracy; force; (especially 

paresis) : limitations. 
Movements, Involuntary: rigidity; tremor (at rest, intention); spasms; 

convulsions. 
Reflexes: KK;' TA; contralat. add.; plantar; cremasteric (inguinal); 

bladder; anal; epigastric; triceps; ulnar; radial; jaw; clonus; (ankle, 

patellar and wrist). 



I9IO] WILLIAM A. WHITE 21 

Nerve-trunk Sensitiveness: Tender Areas: (especially vertebrae, breast, 
ovarian). 

Co-ordination: FN; FF; FT; KH; station (eyes open and closed, one 
and both feet) ; gait. 

Sensations: touch; pain; organic; paresthesia; hypesthesia; hyper- 
esthesia; anesthesia; analgesia; sense of position; feeling of reality. 

Cranial Nerves : 

1. Smell, solutions and subjective. 

2. Hemiopia; fundus; hallucinations. 

3. 4, 6. Eye movetnents (all directions) ; squint; diplopia; ptosis; 

nystagmus (horizontal, vertical, rotary). 
Pupils: Size; outline; direct light; consensual light; accomodation; 
sympathetic. 
5- Corneal reflex ; chewing movements ; taste ; solutions and subjective. 

7. Facial symmetry: (whistling) ; tremors; test-phrases. 

8. Hearing, objective and subjective vertigo. 

9. 10. II. Swallowing ; pharyngeal re-Rex. 
12. Protrusion of tongue. 

In a condition which admittedly involves the central nervous 
organs, particularly the brain, the neurological examination be- 
comes of the greatest importance. Especial importance should be 
paid to the cranial nerve distributions and to the presence of 
paralysis or anesthesias, which might have localizing sigfnificance. 

VII. MENTAL EXAMINATION: 

Orientation : time; place; people. 

General Memory: family; school; occupation; marriage; children; dis- 
eases. 

Emotional Status: Insight; sleep; dreams. 

Hallucinations : auditory; visual; other senses. 

Speech : voluntary; naming; writing; (name, date, the U. S. A., the Com- 
monwealth of Mass.) ; auditory; visual; test-phrases. (Statistical, pertur- 
bation, 3d Riding Artillery Brigade.) 

Stories: (Cowboy, Gilded Boy, Polar Bear, Shark, Good Girl). 

Special Memory: (Civil War; name of two generals; three European 
countries; capital of native State ; President; 45319628; 35984271 ; 487631 ; 
955217; 7368; 9826; 487; 352; 375 Oxford Street; (after 3 or 5 minutes). 

Masselon : (hunter, dog, gun, forest, rabbit; man, wood coal, stove, dinner; 
needle, thread, button, vest; pipe, match, smoke; pen, ink, letter). 

Ziehen: (horse and ox; dwarf and child; lie and mistake; water and ice). 
7X6; 56—18; 23 — 14; 81— g; x— 5 = 17; x — 8=13; have 50c.; 
buy cherries 12c., butter 7c., bread loc. ; how much change? 

Forward and Backward Associations: (month; days of week; 752186, 
35729. 6418, 26s, 497). 

'KK=:knee kick. TA = tendo-Achilles. FN = finger nose. FF = 
finger finger. FT = fingers thumb. KH = knee heel. 



22 STANDARD EXAMINATION OF MENTAL CASES [July 

General Information : Cost of postage; color of stamps; holidays and 

meaning: (Christmas, Easter, 4th of July). 
Finchk: ("The early bird catches the worm"; "Lies have short legs"; 

" Set a thief to catch a thief"; " Burn a candle at both ends"). 
Ethical Questions : 
Drawing Diagram: (after 5 seconds' exposure). 

Here especial caution is needed to avoid recording conclusions. 
For example: Under orientation the patient's actual answers to 
such questions as, When were you born? How old are you? What 
day is this? etc., should be put down. 

The stories which are used have been selected with great care 
and are follows : 

Coivboy Story. — A cowboy from Arizona went to San Francisco with 
his dog, which he left at a dealer's while he purchased a new suit of clothes. 
Dressed finely, he went to the dog, whistled to him, called him by name and 
patted him. But the dog would have nothing to do with him in his new- 
hat and coat but gave a mournful howl. Coaxing was of no effect, so the 
cowboy went away and donned his old garments, whereupon the dog 
immediately showed his wild joy on seeing his master as he thought he 
ought to be. 

Gilded Boy Story. — It is related that at the coronation of one of the popes 
about three hundred years ago a little boy was chosen to act the part of an 
angel; and in order that his appearance might be as gorgeous as possible 
he was covered from head to foot with a coating of gold foil. He was 
soon taken sick and although every known means was employed for his 
recovery, except the removal of his fatal golden covering, he died in a few 
hours. 

Polar Bear Story. — A female polar bear with two cubs was pursued by 
sailors over an ice field. She urged her cubs forward by running before 
them, and as it were, begging them to come on. At last in dread of their 
capture she pushed, then carried and pitched each before her, until they 
actually escaped. The polar bear is a wonderful swimmer and diver. In 
the capture of seals lying on the ice, it dives some distance off and swim- 
ming underneath the water, suddenly comes up close to the seals, cutting 
off their retreat to the sea. 

Good Girl Story. — Once upon a time there was a girl, whose father and 
mother were dead, and who was so poor that finally she had nothing but 
the clothes on her back and a little piece of bread in her hand. She was 
deserted by everybody, but since she was good and honest she went into the 
world with confidence in God. As she went along she was met by a poor 
old man who said " Give me something to eat, I am hungry." The girl 
gave him the piece of bread and went on farther. Soon afterwards she 
encountered a little girl freezing and almost naked, who begged for clothes. 
The good girl gave the poor child the warmest of her garments. Night 
came on, the good girl was tired, cold and hungry. She traveled into the 



I9IO] WILLIAM A. WHITE 23 

woods, and, wandering off the road, she knelt and prayed to God. As she 
knelt she saw the stars falling all about her, and when she looked she 
found they were many bright gold dollars. (Adapted from Ziehen.) 

Shark Story. — The son of a governor of Indiana was first officer on an 
Oriental steamer. When in the Indian Ocean the boat was overtaken by 
a typhoon and was violently tossed about. The officer was suddenly thrown 
overboard. A life preserver was thrown to him, but, on account of the 
heavy sea, difficulty was encountered in launching a boat. The crew, how- 
ever, rushed to the side of the vessel to keep him in sight, but before their 
shuddering eyes the unlucky young man was grasped by one of the sharks 
encircling the steamer and was drawn under the water, leaving only a dark 
streak of blood. (Adapted from Ziehen.) 

These stories are especially valuable. It is remarkable the 
amount of information that one can obtain from getting a patient 
to repeat one or two. Defects of memory and attention show imme- 
diately, while the manic tendency to elaboration is characteristic. 
They should never be omitted. The cowboy story is usually the 
easiest, while the good-girl story is hard, because of the great 
amount of detail. The emotional feature of the " streak of blood " 
in the shark story is particularly impressive and is often about the 
only feature of the story reproduced. 

In the special memory tests, of course, different people will have 
to be treated differently. A Polish immigrant just landed would 
hardly know about the Civil War. The important thing, however, 
is to record actual question and answer. 

In the Masselon tests the patient is asked to incorporate such 
words as pen, ink, letter, into a sentence. In the Ziehen test the 
patient is asked to tell the difference between horse and ox. dwarf 
and child, etc. 

The problem of calculating the change left from 50c. after mak- 
ing certain purchases is an excellent example of the usefulness of 
standard questions. Every one on the staff knows that the answer 
is 2ic. ; and although this is a little thing, when multiplied many 
times it makes a great deal of difference in the ease with which one 
can go over a history or appreciate it when read. 

The forward and backward associations are valuable as roughly 
quantitative. The average person should be able to give six num- 
bers forward and five numbers backward. This test will disclose 
just how many the patient can give and is one of the valuable 
tests for repeating from time to time during the course of the 



24 STANDARD EXAMINATION OF MENTAL CASES [Jl'lv 

psychosis. It is also very valuable in detecting the malingerer. A 
definite intention to blunder is usually readily distinguishable from 
a natural blunder.' 

In the Finchk test the patient is asked the meaning of the sev- 
eral sayings such as " The early bird catches the worm." 

Such ethical questions can be asked as What would you do if 
you saw a man drop a $io bill? 

In addition to the tests given in the table we frequently use the 
Ebbinghaus test which consists of having the patient complete a 
sentence in which certain words have been left out such as : I 

got up in the ..... and after washing my .... went to 

Or better often is Ziehen's modification of this test. The patient 
is asked to complete such a sentence as this : If it rains .... 

because .... in spite of The Bourdon test is very valuable 

as a measure of attention. It consists of getting the patient to 
strike out certain recurring letters or numbers in a standard page 
and timing the result. A similar test is the tapping test — timing 
the number of taps that can be made in a given time, say thirty 
seconds. 

Word association and free association are very valuable in a 
large number of cases as are the methods of psychanalysis gener- 
ally. For obvious reasons they are not entered into here. They 
would require a separate paper for their discussion. 

Of course the cases will be numerous in which it will be found 
desirable or necessary to pursue the examination further in some 
direction. No scheme can cover all possibilities and would be use- 
less if it did, because impossible to carry out. Much must of neces- 
sity be left to the judgment of the examiner. By following this 
plan, however, it is believed that the general and important fea- 
tures necessary for a case record will be covered in the large 
majority of cases. 

It is useful, after completing the examination, to accent the sig- 
nificant features in a short summary, which might include a pro- 
visional diagnosis if the facts warranted. 

Government Hospital for the Insane, Washington, D. C. 

'For more elaborate tests see White: Outlines of Psychiatry. Jour, of 
Nerv. and Ment. Dis. Pub. Co., N. Y., 1909. 



THE IMPORTANCE OF COMPLETE RECORDS OF THE 

INSANE AND A FEW REMARKS, CONCERNING 

CHIEFLY THE PRELIMINARY 

EXAMINATION.* 

By W. W. HAWKE, M. D., 
Philadelphia Hospital for the Insane, Philadelphia, Pa. 

Form of Record. 
Advantages of folder system over books. 
Information from various sources (preserved in folders). 
Writings, drawings and other productions of the patient. 
Correspondence. Important as showing the intelligence and education 
of the relatives. 
Purposes for which blank forms may be used. 
General items for statistics (outside of folder). 
Notification of relatives. 
History from relatives. 
Resident. 
Non-resident. 
Physical notes. 
General. 

Special (urinalysis, etc.). 
Psycho-Physical Experiments, important in special cases. 
Sight, hearing, taste, smell, touch and pam. 
Field of vision. 
Associated movements. 
Astereognosis. 
Sensory and motor aphasia. 
Mental Examinations. 

Importance of favorable conditions. 
Examining room. 
Light and ventilation. Simplicity. 
Freedom from distubances. 
Physical condition of the patient. 

Relief of any relievable discomfort. 
Mental and emotional condition (especially at initial examination). 
Influence of drugs. 

Fright, due to strangeness of surroundings. 
Suspicion or grief. 
Importance of recording any defect in conditions which cannot be over- 
come. 

* Read at the sixty-sixth annual meeting of the .American Medico- 
Psychological Association, Washington, D. C, May 3-6, 1910. 



26 IMPORTANCE OF COMPLETE RECORDS [J"ly 

Initial mental examination. 

1. Importance of securing co-operation of patient, and of giving him 

a fair chance to show his true mental state. 
Avoidance of severe cross-questioning, and other forms of inquiry 

that tend to confuse the patient. 
Avoidance of giving any help by suggestion. 

2. E.\perimental questions. 
Suggestibility and negativism. 

Effect of suggestion upon emotional state. 
Repetition of same question as test for memory. 
Significance and limitations of sensory disturbances as symptoms of 

mental disease. 
Simple tests on attention and memory. 

Limitation of any single method of determining mental condition. 
Recognition of personal equation of patient. 

Importance of considering how a sane person would react to similar 
conditions. 

The care and thought which is given to the records of the 
patients in an institution may generally be taken as a fair index 
to the individual attention which each patient receives. This is 
true for two reasons : In the first place, the physician who takes 
special pains in the care of a patient will be inclined to keep a 
careful record, both in order to call the attention of others to the 
patient, and also in order that he may receive the credit that be- 
longs to him for any improvement in the patient's condition. In 
the second place, a well-kept record of a patient inspires interest on 
the part of all who are concerned in his welfare, and thus works 
in his favor. 

In most institutions the folder system of records has been sub- 
stituted for the books that were formerly used. According to the 
old system, a single book contains all the admissions for a year, 
and the records of all the patients admitted during a given year 
are accessible to but one person at a time. The book of the cur- 
rent year is naturally in almost constant demand, and it is im- 
possible for any one to make his notes as full as they should be 
without encroaching upon the rights of others who wish to use 
the book. All the notes must be written by hand, and as they are 
usually written in great haste, it is not surprising that some of 
them are almost illegible. Only two pages are allowed for the 
record of any patient, and this space is entirely inadequate for a 
patient of long residence in the institution. 



I9IO] W. W. HAWKE 27 

In the folder system the length of the record can be adapted to 
the needs of the individual patient, and the folders can be kept on 
file so as to be easily accessible at all times. It is convenient on 
occasions to have the record of a patient in such form that it can 
be taken away from the hospital for a short time, as, for instance, 
when the patient is taken to a clinic or to court. Whenever pos- 
sible the records should be typewritten. Items of information 
from various sources may be preserved in the folder, such as 
writings, drawings, and other productions of the patient. 

Much of the information about the condition of a patient may 
be given in stereotyped form on printed blanks. It must be kept 
in mind that each patient is an individual, and the blank-form 
method of recording is to be regarded as a supplement to indi- 
vidual observations, rather than as a substitute for them. Even 
then it must be used with caution, because any one who habitually 
depends upon such aids is liable to become careless in his obser- 
vations. The experienced examiner, of course, does not require 
the printed form ; but it is of value to the inexperienced assistant, 
who has not had special training for this work and does not know 
what observations to make. There are certain questions that 
should be asked of every patient, and certain physical observations 
that should be made in each case. It is convenient, both for the 
making and for the reading of the records, that the notes on such 
points should be made according to a fixed plan ; and this uni- 
formity of records is especially helpful to any one who has occa- 
sion to consult a large number of them for statistical purposes. 
But the examiner must never feel that he has done his whole duty 
when he has filled out the various blanks, but should rather allow 
himself the use of this short cut for making the more simple and 
obviously necessary observations, merely in order that he may 
have more time for the careful individual study of each patient 
under his care. 

It may be well to call attention to some of the special items for 
which the blank form may be used to good advantage. 

It is convenient to give the information required by the Lunacy 
Commission, or for other records, and all such as is liable to be 
needed for statistical reports, on the outside of the folder, where it 
may be seen at once. 



28 IMPORTANCE OF COMPLETE RECORDS [J^'v 

As soon as a patient is received into the hospital his relatives or 
friends should be notified of his admission, and it is convenient to 
use a blank form for this purpose. It is almost as important — 
and a good deal more difficult — for the physician to be on friendly 
terms with the relatives as with the patients. Sometimes they are 
as much in need of asylum care as is the patient himself, and it is 
an almost hopeless task for the physician to try to show them that 
he is working in the interest of the patient, and detaining him for 
his own good. Whenever the relatives are disposed to try to 
secure the release of the patient long before he can be safely cared 
for at home, their visits are almost sure to have a disturbing and 
detrimental effect upon the patient. It is, therefore, of the utmost 
importance that the physician should gain their confidence at the 
start, and enlist their co-operation in keeping the patient contented 
while he is in the hospital. The first step in the direction of a 
friendly understanding with the relatives is the prompt notification 
of the admission of the patient. 

Another purpose for which the blank form may be used is for 
obtaining an early history of the disease from the relatives. This 
form should be very simple, so as to allow ample freedom for 
individual questions, because the physician who is experienced in 
taking histories will think of many questions which are not sig- 
nificant in all cases and which would, therefore, be out of place in 
printed form. But it is well to have another form especially de- 
signed for non-resident relatives who cannot give the physician a 
personal interview. This form should be as complete as possible, 
and each question should be definite, simple, non-technical, and 
so worded as to involve the least possible difficulty in the answer. 

A general physical examination should be made of each patient 
received into the hospital, and this should be as complete as pos- 
sible. If the condition of the patient permits, this examination 
should be made very soon after his admission. But frequently his 
condition is such that he would be unduly disturbed by it, and the 
effect might be detrimental to his health. A successful examina- 
tion requires some co-operation on the part of the patient, and if he 
is unable or unwilling to do his part, it is better to make notes on 
his general condition and on any special symptoms that are ob- 
served, and reserve the prolonged examination until a more favor- 



19 lo] W. W. HAWKE 29 

able time. Great care should be taken to avoid giving the patient 
any unnecessary annoyance, and if he becomes very restive under 
the examination it may be well to postpone part of it until another 
time. In case the examination is at best unsatisfactory, a note 
should be made of the fact and the apparent reasons for it. A 
brief description of the mental condition at the time of the ex- 
amination should always be given, with special care to make note 
of any mental tendency that would have a bearing upon the relia- 
bility of the results of the examination. 

Printed or stamped fomis showing the viscera and body out- 
line are often of service in recording the findings of the examiner. 
Heart munnurs may be traced upon such a form, and all injuries, 
scars, tumors and anaesthetic areas may be accurately located. 

A complete analysis of the urine should always be made and 
recorded upon a special chart as soon as possible after the patient 
is admitted. 

Mention should always be made of the keenness of sight, hear- 
ing, taste and smell, and especially of the sensitivity to touch and 
pain. These points may usually be noted with sufficient accuracy 
by simple observation or by rough experiments, such as any one 
can make without special apparatus. One may have a fair idea of 
the sensitivity to touch, for instance, by observing how much 
attention the patient pays to a fly that lights on his body during 
the examination. It is advisable, however, to make more careful 
and accurate experiments for determining any such factors which 
appear to have a special bearing upon the mental condition of the 
patient. Other psycho-physical experiments, which are useful in 
special cases, are the tests for the field of vision, the tendency to 
associated movements, sensory and motor aphasia and astereo- 
gnosis. 

Aside from the intrinsic importance of the physical examina- 
tion, it is also of great significance by reason of the light which it 
throws upon the mental condition of the patient. 

The mental examination should be made under the most favor- 
able conditions that can be secured, so that the patient may have a 
fair chance to show his true mental state, rather than his passing 
mood. This is especially important in the case of a newly- 
admitted patient. The law in Pennsylvania requires that a pro- 



30 IMPORTANCE OF COMPLETE RECORDS [Jl'lv 

visional mental diagnosis of each case be made within twenty-four 
hours of the admission of the patient, and, consequently, it is 
necessary to make the initial mental examination immediately after 
the admission. This is, in many cases, an unfavorable time. The 
patient may be under the influence of a sedative or other drug, so 
that it is difficult to arouse him to full consciousness of his sur- 
roundings. He may have been brought to the hospital under some 
false pretense, in which case he is liable to be excited and angry 
when he learns where he is, or he may be overcome by fear be- 
cause he does not know. It may be necessary to make the ex- 
amination in spite of these disadvantages, but, whenever it is 
evident that the patient's mental condition is seriously affected by 
the strangeness of his surroundings, it is well to make a note of 
the fact. 

The examining room should be in a quiet part of the building, 
so as to be free from disturbances from outside. It should be well 
lighted, and very plainly furnished, with no unnecessary fixtures, 
wall decorations, or anything that would tend to distract the atten- 
tion of the patient from the examination. The room should be of 
comfortable temperature and well ventilated. 

The patient should be made as comfortable as the circumstances 
permit. If he is suffering from thirst, it should be relieved 
before the examination is begun. If he is in pain, the fact should 
be noted. 

It is not always possible to make the conditions meet all the ideal 
requirements, but it is possible, when the defects are serious 
enough to have a decided bearing upon the mood of the patient, to 
put on record a brief statement of the fact. 

The physician should endeavor by every means to secure the 
confidence of the patient, both in order to have the best possible 
opportunity to understand his condition and also as a therapeutic 
measure. A good rule to follow is to be honest with the patient, 
and never make any promise that cannot be kept. If the patient 
feels that he has been deceived by the physician, he is liable to 
become suspicious of the whole institution ; and this impression, 
once formed, is difficult to overcome. The physician should bear 
this in mind at the time of the initial mental examination, when a 
little tact and courtesy will go a long way toward making the 



igio] W. W. HAWKE 31 

patient content to remain in the hospital and to obey the medical 
instructions. 

The initial mental examination may for convenience be divided 
into two parts, although the dividing line should not be apparent 
to any one except the examiner. The purpose of the first part is 
to see how coherent and how correct an account of himself a patient 
can give, unaided by any suggestions from the examiner. Severe 
cross-questioning should be avoided, and all forms of inquiry that 
would tend to confuse the patient. On the other hand, it is not 
advisable, in this part of the examination, to give him any direct 
help in expressing himself, or to ask a question in such a way as 
to imply what answer is expected. Many of the statements of a 
patient, especially about his delusions and hallucinations, are 
much more significant when made spontaneously than when drawn 
from him by direct questions. 

When the examiner makes a definite attempt to elicit hallucina- 
tions he is liable to find what he is looking for, whether it is there 
or not. Even an unprejudiced and experienced examiner may 
become confused as to which of the patient's answers are founded 
on fact and which are given merely in response to suggestion. 
Patients who were entirely free from hallucinations have been 
known to acknowledge them in answer to questions, sometimes 
because of a tendency to accept without reflection any suggestion 
that is offered, sometimes because they think the examiner is in- 
quiring about their dreams, and take it for granted that he will 
understand that they are relating dreams, and occasionally because 
they think the questions are too foolish to be taken seriously, and 
assent to all questions merely to make sport of the examiner. It 
is plain that some of these sources of error may be avoided by 
making the first questions as general as fKDssible, so as to give the 
patient a chance to tell his story in his own way. After he has 
given all the information he is disposed to give, questions may be 
used more freely, but they should not be too direct. Sometimes a 
patient who is trying to conceal his delusions and hallucinations, 
and who would deny them if questioned directly about them, may 
disclose them without knowing it in his answers to questions on 
other subjects. 

In the second part of the examination the purpose of the ques- 



32 IMPORTANCE OF COMPLETE RECORDS [July 

tions is not to obtain information from the patient, but merely to 
determine how he will answer them. Questions asked with this 
view may be called experimental questions and they are useful for 
several purposes. It is permissible, in this part of the examina- 
tion, to give suggestions of varying degrees of directness, in order 
to see how readily the patient responds to suggestion. 

Suggestibility is of considerable significance as a symptom and 
it is important to note its presence. Negativism is also an im- 
portant symptom which may sometimes be observed by means of 
suggestive questions. The effect of suggestion upon the mood or 
emotional state of a patient should also be observed. If he can be 
made either happy or depressed by the questions of the examiner, 
or if he shows amusement or resentment at other questions, the 
variability of his mood is of significance in diagnosis. Suggestions 
of this nature are important, also, as showing in what cases sug- 
gestive therapeutic measures are most likely to be of use. 

In many cases it is of interest to repeat certain questions at 
intervals during the examination in order to see how well the 
answers will agree. If they are contradictory it should be noted 
whether the inconsistency appears to be from loss of memory, 
from inattention and careless indifference, or from ignorance and 
illiteracy. If there is evidence of positive inability to recall, it 
should be observed for what kind of events, and for what time of 
life the memory is most impaired. If the patient's attention is 
called to the inconsistency, it should be noted if he attempts to 
explain and reconcile the contradictory statements, if he acknowl- 
edges that he is mixed up, or if he becomes irritated. 

It is of great importance that all notes on hallucinations and 
other sensory disturbances should be accurate, because, if not so, 
they may be very misleading. Hallucinations are especially char- 
acteristic of certain forms of mental disease, and, for this reason, 
their significance is liable to be overestimated. As has already 
been shown, the frank statement of a patient that he sees visions 
and hears voices does not always indicate that he has true hallu- 
cinations. Even if it is reasonably certain that the patient intends 
to be truthful in his description of his visions, it is not safe for the 
examiner to accept his account of them until he has ascertained 
whether the patient refers to dreams or waking experiences. That 



igiO] W. W. HAWKE 33 

a patient should mistake a dream for a real experience is not in 
itself an indication of insanity. Almost any one may be deceived 
by a dream that is in every way consistent with real life. Some 
dreams are more vivid, more interesting, and more distinctly 
remembered than are some experiences of real life or a dream-like 
event. We cannot depend entirely upon our sense of reality ; we 
usually decide the matter by means of some external evidence. 
We are not deceived by a dream that conflicts with the laws of 
space, time, gravity and energy, because we have more confidence 
in these laws than in our senses. In like manner, we regard as a 
dream any experience, however possible in itself, which conflicts 
with the experience of yesterday as we remember it. If we know 
that we were in Philadelphia all day yesterday, we are no more 
liable to be deceived by a dream of a trip to New York than by a 
dream of a trip to the moon. But we may be deceived by a dream 
of an insignificant event which, if real, would occupy but a moment 
of time. A man who is accustomed to being called in the morning 
may be wholly at a loss to know whether the call which he seemed 
to hear a few minutes ago was a dream or a real experience. How- 
ever much he would like to regard it as a dream, he may have so 
distinct a memorj' of having heard and answered the call that he 
rises without looking at his watch and learns later, to his great 
sorrow, that he has needlessly sacrificed several minutes that he 
might have spent in bed. 

In distinguishing between dreams and real events, the educated 
man has a great advantage over the uneducated. The ignorant 
man, having but little knowledge of natural laws, places undue 
reliance upon his senses, and consequently is the more often de- 
ceived. Any one who believes in ghosts is as liable to be deceived 
by a dream of a ghost in his bedroom as by a dream of looking 
at his watch or of hearing the call to rise. 

Ignorance and superstitution are probably responsible for a 
considerable number of the visions and fantastic ideas that go 
down upon our records as hallucinations and delusions. It may 
sometimes be impossible to find out with certainty whether a 
patient is delusional or merely superstitious, but in such cases the 
examiner should put on record a note about the general intelligence 
of the patient and leave the reader of the record to draw his own 
conclusions. 
3 



34 ' IMPORTANCE OF COMPLETE RECORDS [July 

When hallucinations are known to be present, it still remains to 
be determined what bearing, if any, they have upon the mental 
condition of the patient. Many sane persons have had hallucina- 
tions, and they are by no means inseparable from mental disease. 
The significance of hallucinations lies rather in their effect upon 
conduct than upon the mere fact of sense deception. It makes 
little difference whether the effect upon conduct is good or bad ; 
it is sufficient to show that they have any effect. Visions are too 
uncertain to be regarded as a safe guide for conduct, and the man 
who depends upon them in regulating his life is an unsafe person 
to be at large. If sensory disturbances were always observed with 
reference to their bearing on the habits of thought and action of 
the patient, much unnecessary confusion and misunderstanding 
might be avoided. When the presence of hallucinations is re- 
corded in the history of a patient, it should be accompanied by a 
statement about the patient's attitude toward his sensory disturb- 
ances, in order to show what tendency there is for the hallucina- 
tions to give rise to fixed delusions, and especially to show how far 
they are liable to influence the patient's conduct. 

In special cases it is helpful to make simple tests on the atten- 
tion, memory and other mental processes. Arithmetical calcula- 
tions may be used for this purpose, or the patient may be requested 
to memorize a series of numbers, letters, or words, the object being 
to determine the length of time required for the process. It is not 
advisable to attempt such tests in all cases, but only upon such 
patients as are able and willing to co-operate. The test should be 
adapted, more or less, to the individual patient, so as to conform 
to his ability, education and interests. The purpose of the test is 
to aid the examiner in understanding the condition of a particular 
patient, rather than to form a standard for comparison between 
different patients. The ability of any person along any line is 
determined by individual factors, and it would not be safe to draw 
conclusions from the record of a given patient as compared with 
that of another patient, or as compared with that of a sane person. 
But the comparison of different records of the same patient, taken 
at different times, may be significant in showing the progress of 
convalescence or deterioration, and the general attitude of the 
patient toward the test — his willingness or reluctance to comply 



igiO] W. W. HAWKE 35 

with the conditions and his interest or indifference as to what kind 
of a record he is making — may give the examiner some insight 
into his mental condition, independently of the results. 

There are many methods of observing the insane, each of which 
is useful in its own way, but none of which will suffice for the 
examination of all patients. The personal equation of each patient 
is a factor which should always be recognized, and to determine 
which of the methods are best suited to a given patient, one needs 
a moderate supply of common sense — a faculty which is not wholly 
at a discount even when one is dealing with sane persons. It is a 
good plan to always consider in what manner a sane person would 
react to similar conditions. 

It may be seen from the records of any asylum, how much care 
is taken to understand each patient as an individual. Everv physi- 
cian who has charge of a very large number of patients is in dan- 
ger of drifting into a narrow routine of work ; and this tendency 
may be seen in the mechanical similarity of the records of different 
patients, and in the oft-repeated statement that a patient is con- 
fused or that he has hallucinations. But the records of a physician 
who makes all possible effort to keep out of ruts may be easily 
distinguished from the records of one who habitually thinks of a 
patient merely as a patient — as if all patients were alike. 



A STUDY OF ASSOCIATION IN INSANITY. 

By grace HELEN KENT, A. M., and A. J. ROSANOFF, M. D., 
Kings Park State Hospital, N. Y. 

PART I. ASSOCIATION IN NORMAL SUBJECTS. 

Among the most striking and commonly observed manifestations 
of insanity are certain disorders of the flow of utterance which 
appear to be dependent upon a derangement of the psychical proc- 
esses commonly termed association of ideas. These disorders 
have to some extent been made the subject of psychological ex- 
perimentation, and the object of this investigation is to continue 
and extend the study of these phenomena by an application of the 
experimental method known as the association test. 

§ I. Method of Investigation. 

In this investigation we have followed a modified form of the 
method developed by Sommer,' the essential feature of which is the 
statistical treatment of results obtained by uniform technique from 
a large number of cases. 

The stimulus consists of a series of one hundred spoken words, 
to each of which the subject is directed to react by the first word 
which it makes him think of. In the selection of the stimulus 
words, sixty-six of which were taken from the list suggested by 
Sommer, we have taken care to avoid such words as are especially 
liable to call up personal experiences, and have so arranged the 
words as to separate any two which bear an obviously close rela- 
tion to one another. After much preliminary experimentation we 
adopted the following list of words : 



1 Table— 


11 Black 


21 Sweet 


31 Rough — 


41 High 


2 Dark — 


12 Mutton 


22 Whistle 


32 Citizen 


42 Working 


3 Music — 


13 Comfort 


23 Woman 


.33 Foot 


43 Sour 


4 Sickness — 


14 Hand 


24 Cold 


34 Spider 


44 Earth — - 


5 Man — 


15 Short 


25 Slow 


35 Needle 


45 Trouble 


6 Deep 


16 Fruit 


26 Wish 


36 Red 


46 Soldier ■ 


7 Soft 


17 Butterfly -^ 


27 River — 


37 Sleep 


47 Cabbage — 


8 Eating 


18 Smooth — 


28 White 


38 Anger — ■ 


48 Hard 


9 Mountain — 


19 Command - — ' 


29 Beautiful 


39 Carpet 


49 Eagle 


10 House — ■ 


20 Chair 


30 Window — 


40 Girl 


60 Stomach 


' Diagiiostik der Geisteskrankheiten, p. ii2. 
4 







38 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



61 Stem 


61 Memory 


71 Stove — 


81 Butter - 


91 Moon -^ 


62 Lamp .- - 


62 Sheep — 


72 Long 


82 Doctor ' 


92 Scissors-" 


6S Dream 


63 Bath — 


73 Religion 


83 Loud 


93 Quiet 


54 Yellow 


64 Cottage 


74 Whiskey 


84 ThieJ 


94 Green 


65 Bread ■ 


65 Swift 


75 Child 


85 Lion — 


95 Salt - 


66 JusHce 


66 Blue 


76 Bitter 


86 Joy 


96 Street • — 


67 Bov 


67 Hungry 


77 Hammer 


87 Bed — 


97 King — 


58 Light 


68 Priest 


78 Thirsty 


88 Heavy 


98 Cheese — 


69 Health 


69 Ocean — 


79 City - 


89 Tobacco - 


99 Blossom 


60 Bible - 


70 Head 


80 Square — 


90 Baby - 


100 Afraid 



No attempt is made to secure uniformity of external conditions 
for the test ; the aim has been rather to make it so simple as to ren- 
der strictly experimental conditions unnecessary. The test may 
be made in any room that is reasonably free from distracting in- 
fluences; the subject is seated with his back toward the experi- 
menter, so that he cannot see the record ; he is requested to respond 
to each stimulus word by one word, the first word that occurs to 
him other than the stimulus word itself, and on no account more 
than one word. If an untrained subject reacts by a sentence or 
phrase, a compound word, or a different grammatical form of the 
stimulus word, the reaction is left unrecorded, and the stimulus 
word is repeated at the close of the test. 

In this investigation no account is taken of the reaction time. 
The reasons for this will be explained later. 

The general plan has been first to apply the test to normal per- 
sons, so as to derive empirically a normal standard and to deter- 
mine, if possible, the nature and limits of normal variation ; and 
then to apply it to cases of various forms of insanity and to compare 
the results with the normal standard, with a view to determining 
the nature of pathological variation. 

§ 2. The Normal Standard. 

In order to establish a standard which should fairly represent at 
least all the common types of association and which should show 
the extent of such variation as might be due to differences in sex, 
temperament, education, and environment, we have applied the 
test to over one thousand normal subjects. 

Among these subjects were persons of both sexes and of ages 
ranging from eight years to over eighty years, persons following 
different occupations, possessing various degrees of mental ca- 
pacity and education, and living in widely separated localities. 
Many were from Ireland, and some of these had but recently ar- 
rived in this country ; others were from different parts of Europe, 



igio] GRACE HELEN KENT AND A. J. ROSANOFF 39 

but all were able to speak English with at least fair fluency. Over 
two hundred of the subjects, including a few university professors 
and other highly practiced observers, were professional men and 
women or college students. About five hundred were employed in 
one or another of the New York State hospitals for the insane, 
either as nurses and attendants or as workers at various trades; 
the majority of these were persons of common school education, 
but the group includes also, on the one hand, a considerable num- 
ber of high school graduates ; and on the other hand, a few labor- 
ers who were almost or wholly illiterate. Nearly one hundred and 
fifty of the subjects were boys and girls of high school age, pupils 
of the Ethical Culture School, New York Cit>'. The remaining 
subjects form a miscellaneous group, consisting largely of clerks 
and farmers. 

§ 3. The Frequency Tables. 

From the records obtained from these normal subjects, including 
in all 100,000 reactions, we have compiled a series of tables, one for 
each stimulus word, showing all the different reactions given by 
one thousand subjects in response to that stimulus word, and the 
frequency with which each reaction has occurred.^ These tables 
will be found at the end of the first part of this paper. 

With the exception of a few distinctive proper names, which are 
indicated by initials, we have followed the plan of introducing each 
word into the table exactly as it was found in the record. In the 
arrangement of the words in each table, we have placed together 
all the derivatives of a single root, regardless of the strict alpha- 
betical order.' 

' A similar method of treating associations has been used by Cattell 
(Mind, Vol. XII, p. 68; Vol. XIV, p. 230), and more recently by Reinhold 
(Zeitschr. f. Psychol., Vol. LIV, p. 183), but for other purposes. 

' It should be mentioned that we have discovered a few errors in these 
tables. Some of these were made in compiling them from the records, and 
were evidently due to the assistant's difficulty of reading a strange hand- 
writing. Other errors have been found in the records themselves. Each 
of the stimulus words butler, tobacco and king appears from the tables to 
have been repeated by a subject as a reaction; such a reaction, had it 
occurred, would not have been accepted, and it is plain that the experimenter 
wrote the stimulus word in the space where the reaction word should have 
been written. Still other errors were due to the experimenter's failure to 



40 A STUDY OF ASSOCIATION IN INSANITY [J"ly 

The total number of different words elicited in response to any 
stimulus word is limited, varj'ing from two hundred and eighty 
words in response to anger to seventy-two words in response to 
needle. Futhermore, for the great majority of subjects the limits 
are still narrower ; to take a striking instance, in response to dark 
eight hundred subjects gave one or another of the following seven 
words : light, night, black, color, room, bright, gloomy; while only 
two hundred gave reactions other than these words ; and only 
seventy subjects, out of the total number of one thousand, gave 
reactions which were not given by any other subject. 

If any record obtained by this method be examined by referring 
to the frequency tables, the reactions contained in it will fall into 
two classes : the common reactions, those which are to be found in 
the tables, and the individual reactions, those which are not to be 
found in the tables. For the sake of accuracy, any reaction word 
which is not found in the table in its identical form, but which 
is a grammatical variant of a word found there, may be classed as 
doubtful. 

The value of any reaction may be expressed by the figure rep- 
resenting the percentage of subjects who gave it. Thus the reac- 
tion, table — chair, which was given by two hundred and sixty- 
seven out of the total of our one thousand subjects, possesses a 
value of 26.7 per cent. The significance of this value from the 
clinical standpoint will be discussed later. 

§ 4. Normal Associational Tendencies. 

The normal subjects gave, on the average, 6.8 per cent of indi- 
vidual reactions, 1.5 per cent of doubtful ones, and 91.7 per cent of 
common ones. The range of variation was rather wide, a con- 
siderable number of subjects giving no individual reactions at all, 
while a few gave over 30 per cent.' 

speak with sufficient distinctness when reading off the stimulus words ; thus, 
the reaction barks in response to dark indicates that the stimulus word was 
probably understood as dog; and the reactions blue and color in response to 
bread indicate that the stimulus word was understood as red. 

*In the study of the reactions furnished by our normal subjects it was 
possible to analyze the record of any subject only by removing it from the 
mass of material which forms our tables, and using as the standard of com- 
parison the reactions of the remaining 999 subjects. 



ipiO] GRACE HELEN KENT AND A. J. ROSANOFF 4I 

In order to determine the influence of age, sex, and education 
ufKJn the tendency to give reactions of various values, we have 
selected three groups of subjects for special study: (i) one hun- 
dred persons of collegiate or professional education ; (2) one hun- 
dred persons of common school education, employed in one of the 
State hospitals as attendants, but not as trained nurses; and (3) 
seventy-eight children under sixteen years of age. The reactions 
given by these subjects have been classified according to frequency 
of occurrence into seven groups: (a) individual reactions (value 
o) ; (b) doubtful reactions (value it) ; (c) reactions given by one 
other person (value o.i per cent) ; (d) those given by from two to 
five others (value 0.2 — 0.5 per cent) ; (e) those given by from 
six to fifteen others (value 0.6 — 1.5 per cent) ; (f) those given 
by from sixteen to one hundred others (value 1.6 — lo.o per cent) ; 
and (g) those given by more than one hundred others (value over 
lo.o per cent) . The averages obtained from these groups of sub- 
jects are shown in Table I, and the figures for men and women 
are given separately. 











TABLE I. 












Value of reactions 







± 


0.1% 


0.2.0.5% 


0.6-1.5% 


1.6-10% 


Over 

10% 

% 




Sex 


Number 
of cases 


% 


% 


% 


% 


% 


% 


Persons of 


M. .. 


.. 60 


9.2 


1.3 


5.2 


9.7 


11.0 


27.8 


35.5 


collegiate 


F. .. 


.. 40 


9.5 


1.3 


3.9 


9.8 


11.7 


28.9 


33.4 


education 


Both 


.. 100 


9.3 


1.3 


4.7 


9.7 


11.3 


28.2 


34.4 


Persons of 


ra. .. 


.. 50 


5.8 


1.6 


3.6 


8.3 


10.2 


31.6 


38.7 


common school. 


If. .. 


.. 50 


4.6 


1.3 


3.3 


7.1 


9.4 


32.0 


42.1 


education 


[Both 


.. 100 


5.2 


1.4 


3.5 


7.7 


9.8 


31.8 


40.4 


School children 


■M. .. 


.. 33 


5.9 


0.8 


4.2 


8.7 


10.6 


28.5 


38.5 


under 16 


F. .. 


.. 45 


5.6 


1.9 


4.6 


9.8 


11.6 


30.1 


36.7 


years of age 


Both 


.. 78 


6.7 


1.4 


4.5 


9.3 


11.2 


29.4 


37.4 


General average.. 


. .Both 


..1000 


6.S 


1.5 













It will be observed that the proportion of individual reactions 
given by the subjects of collegiate education is slightly above the 
general average for all subjects, while that of each of the other 
classes is below the general average. In view, however, of the wide 
limits of variation among the thousand subjects, these deviations 
from the general average are no larger than might quite possibly 
occur by chance, and the number of cases in each group is so small 
that the conclusion that education tends to increase the number of 
individual reactions would hardly be justified. 



A STUDY OF ASSOCIATION IN INSANITY 



:j"iy 



It will be observed also that this comparative study does not 
show any considerable differences corresponding to age or sex. 

With regard to the type of reaction, it is possible to select groups 
of records which present more or less consistently one of tlie fol- 
lowing special tendencies : (i) the tendency to react by contrasts ; 

(2) the tendency to react by synonyms or other defining terms ; and 

(3) the tendency to react by qualifying or specifying terms. How 
clearly the selected groups show these tendencies is indicated by 
Table II. The majority of records, however, present no such ten- 
dency in a consistent way ; nor is there any evidence to show that 
these tendencies, when they occur, are to be regarded as mani- 
festations of permanent mental characteristics, since they might 
quite possibly be due to a more or less accidental and transient 
associational direction. No further study has as yet been made of 
these tendencies, for the reason that they do not appear to possess 
any pathological significance. 



TABLE n. 



stimulus 
word. 



1. Table. 



7. Soft. 



Special group values. 



General Contrasting group Defining group Specifying group 



value. 

% 
.. 26.7 
.. 7.5 
.. 1.0 
.. 7.6 

cotton 2.8 

easy 3.4 

feathers 2.4 



{chair . . . 
furniture 
round . . . 
wood ... 



49 subjects. 
No. % 

25 51.0 



1 2.0 

2 4.1 



73 subjects. 

No. % 

11 15.1 

13 17.8 



9 12.3 



84 subjects. 



XL Black... ^ 



26. Wish. 



29. Beau- 
tiful. 



hard .. 
silk ... 

sponge 

cloth . 
color . 
dress . 
ink .. . 



.... 36.5 

.... 1.0 

2.2 

.... 1.7 

.... 12.9 

.... 2.9 

.... 1.4 

White 33.9 

fdesire 19-7 

J longing 1.9 

I money 3.2 

'flowers 4.2 

girl 2.4 

homely 2.7 

lovely 6.4 

pleasing 1.6 

sky 1.6 

ugly 6.6 






34 



1 



1 


31 

7 
1 




3 
2 


13 







69.4 



2.0 


2.0 



63.3 

14.3 
2.0 
U 

Q 


6.1 
4.1 





26.5 



1 

14 







20 

1 

1 

17 



1.4 
11.0 

1.4 
19.2 







27.4 
1.4 
1.4 

23.3 

28.8 



1.4 





9.6 

4.1 



4.1 



No. 

10 
4 
4 

10 

5 
1 

5 

18 
2 
4 



9 
4 
13 

10 
2 
3 

7 
S 

2 


3 




% 

11.9 
4.8 
4.5 

11.9 

6.0 
1.2 
6.0 
21.4 
2.4 
4.3 

3.6 

7.1 
10.7 

4.8 
21.4 

11.9 
2.4 
3.6 

8.3 

6.0 



2.4 



3.6 





i9ioJ 



GRACE HELEN KENT AND A. J. ROSANOFF 



43 



TABLE n. -Continued. 



59. Health. 



65. Swift. 



{court 6.4 
injustice 2.6 
right 15.7 

comfort 2.6 

disease 0.9 

.^ good 9.4 

sickness 15.3 

[strength 11.2 

arrow 1.3 

fast 22.2 

horse 2.8 

quick 11.7 

run 1.9 

runner 1.3 

slow 19.0 

speed 2.9 

'disagreeable 1.0 

distasteful 1.0 

gall 4.2 

"l medicine 3.7 

quinine 2.3 

sweet 30.5 

Ltaste 6.6 

bread 20.6 

eatable 1.2 

food 6.3 

sweet 1.2 

yellow 8.0 

'gladness 4.4 

grief 1.8 

pleasure 12.1 

sadness 1.3 

sorrow 13.5 



76. Bitter. 



81. Butter. 



86. Joy - 



2 


4.1 


5 


6.8 


10 


11.9 


6 


12.2 


1 


1.4 








3 


6.1 


20 


27.4 


13 


15.5 








5 


6.8 


1 


1.2 


2 


4.1 








1 


1.2 


2 


4.1 


8 


11.0 


18 


21.4 


23 


46.9 


6 


8.2 


1 


1.2 


2 


4.1 


12 


16.4 


4 


4.8 














2 


2.4 








25 


34.2 


15 


17.9 


1 


2.0 


1 


1.4 


6 


7.1 


1 


2.0 


22 


30.1 


2 


2.4 














4 


4.S 





n 








1 


1.2 


30 


61.2 


2 


2.7 


4 


4.8 


1 


2.0 


5 


6.8 














2 


2.7 














4 


6.5 














2 


2.7 


8 


9.5 














3 


3.6 














6 


7.1 


31 


63.3 


8 


11.0 


12 


14.3 


1 


2.0 


17 


23.3 


3 


3.6 


17 


34.7 


4 


5.5 


18 


21.4 








9 


12.3 








1 


2.0 


14 


19.2 


3 


3.6 














3 


Z.6 














18 


21.4 








7 


9.6 


1 


1.2 


4 


8.2 














1 


2.0 


13 


17.8 


7 


8.3 


2 


4.1 














23 


46.9 


2 


2.7 


2 


2.4 



§ 5. Practical Considerations. 

This method is so simple that it requires but little training on the 
part of the experimenter, and but little co-operation on the part of 
the subject. It is not to be assumed that every reaction obtained 
by it is a true and immediate association to the corresponding 
stimulus word ; but we have found it sufficient for the purpose of 
the test if the subject can be induced to give, in response to each 
stimulus word, any one word other than the stimulus word itself. 
No attempt is made to determine the exact degree of co-operation 
in any case. 



44 A STUDY OF ASSOCIATION IN INSANITY [Jl'ly 

In the early stages of this investigation the reaction time was 
regularly recorded. The results showed remarkable variations, 
among both normal and insane subjects. In a series of twenty-five 
tests, made more recently upon normal subjects, ninety reactions 
occupied more than ten seconds, and fifty-four of the stimulus 
words elicited a ten-second response from at least one subject." 

It is noteworthy that these extremely long intervals occur in 
connection with reactions of widely differing values. That they 
are by no means limited to individual reactions is shown in Table 
III. by a group of selected reactions, all given by normal subjects. 

TABLE III. 

Word combination Reaction time Value of 

in seconds. reaction. 

comfort — happiness 20 5.0% 

short— long H 27.9% 

smooth— plane 16 2.3% 

woman — lady 40 4.1% 

hard— iron 12 2.4% 

justice — judge 20 9.1% 

memory— thought 20 8.1% 

joy— pleasure 18 12.1% 

It is apparent, even from a superficial examination of the mate- 
rial, that the factors which cause variations of reaction time, both 
in the normal state and in pathological states, are numerous and 
complex. 

It has been the purpose of this study to establish as far as pos- 
sible strictly objective criteria for distinguishing normal from 
abnormal associations, and for this reason we have made no at- 
tempt to determine by means of introspection the causes of varia- 
tions of reaction time. 

It would seem that the importance and magnitude of the prob- 
lem of association time are such as to demand not merely a crude 
measurement of the gross reaction time in a large number of cases, 
but rather a special investigation by such exact methods as have 
been used by Cattell ' and others in the analysis of the complex 
reaction. It would be impracticable for us to employ such meth- 
ods in a study so extensive as this. 

In view of these considerations we discontinued the recording 
of the reaction time. 

"These tests were made by Dr. F. Lyman Wells, of the McLean Hos- 
pital, Waverley, Mass., and he has kindly furnished these data. 
• Mind. Vol. XI, i886. 



I9IO] GRACE HELEN KENT AND A. J. ROSANOFF 45 

If the association test is to be useful in the study of pathological 
conditions, it is of great importance to have a reliable measure of 
the associational value of a pair of ideas. Many attempts have 
been made to modify and amplify the classical grouping of asso- 
ciations according to similarity, contrast, contiguity, and se- 
quence, so as to make it serviceable in differentiating between 
normal and abnormal associations. 

In this study we attempted to apply Aschaffenburg's ' classifica- 
tion of reactions, but without success. Our failure to utilize this 
system of classification is assigned to the following considera- 
tions: (i) Distinctions between associations according to logical 
relations are extremely difficult to define; in many cases there is 
room for difference of opinion as to the proper place for an asso- 
ciation, and thus the application of a logical scheme depends 
largely upon the personal equation of the observer ; that even ex- 
perienced observers cannot, in all cases, agree in placing an asso- 
ciation is shown by Aschaffenburg's criticisms of the opinions of 
other observers on this point.' (2) Logical distinctions do not 
bring out clearly the differences between the reactions of normal 
subjects and those of insane subjects ; logically, the reaction bath — 
ink, which was given by a patient, might be placed in the class 
with the reaction bath — water, although there is an obvious differ- 
ence between the two reactions. (3) Many of the reactions given 
by insane subjects possess no obvious logical value whatever; but 
since any combination of ideas may represent a relationship, either 
real or imagined, it would be arbitrary to characterize such a 
reaction as incoherent. 

The criterion of values which is used in this study is an empir- 
ical one. As has already been explained (p. 40), every word con- 
tained in the frequency tables possesses a value of at least o.i per 
cent, and other words have a zero value. With the aid of our 
method the difficulty of classifying the reactions quoted above is 
obviated, as it is necessary only to refer to the table to find their 
proper values : the value of the reaction bath — water is 33.9 per 
cent, while that of the reaction batJi — ink is o. 

' Experitnentelle Studien iiber Association. Psychologische Arbeiten, 
Vol. I, p. 209; Vol. II, p. i; Vol. IV, p. 235. 
'Loc. cit.. Vol. I, pp. 226-227. 



46 A STUDY OF ASSOCIATION IN INSANITY [July 

Logically the combination health — ivealth may be placed in any 
one of four classes, as follows : 

{. , . . Tcausal dependence 
intrinsic-^ ,. : 

I coordination 
fspeech reminiscence 
extrins.cj^^y^j similarity 

But since our table shows this association to have an empirical 
value of 7.6 per cent, it becomes immaterial which of its logical 
relations is to be considered the strongest. It is mainly important, 
from our point of view, to separate reactions possessing an empir- 
ical value from those whose value is zero. 

§ 6. An Empirical Principle of Normal Association. 

On a general survey of the whole mass of material which forms 
the basis of the first part of this study, we are led to observe that 
the one tendency which appears to be almost universal among 
normal persons is the tendency to give in response to any stimulus 
word one or another of a small group of common reactions. 

It appears from the pathological material now on hand that this 
tendency is greatly weakened in some cases of mental disease. 
Many patients have given more than 50 per cent of individual 
reactions. 

It should be mentioned that occasionally a presumably normal 
subject has given a record very similar to those obtained from 
patients, in respect to both the number and the nature of the indi- 
vidual reactions. A few subjects who gave peculiar reactions were 
known to possess significant eccentricities, and for this reason we 
excluded their records from the thousand records which furnished 
the basis for the frequency tables ; we excluded also a few peculiar 
records obtained from subjects of whom nothing was known, on 
the ground that such records would serve only to make the tables 
more cumbersome, without adding anything to their practical 
value. The total number of records thus excluded was seventeen. 

It will be apparent to anyone who examines the frequency tables 
that the reactions obtained from one thousand persons fall short 
of exhausting the normal associational possibilities of these stimu- 
lus words. The tables, however, have been found to be sufficiently 
inclusive for the practical purpose which they were intended to 



I9IO] GRACE HELEN KENT AND A. J. ROSANOFF 47 

serve. Common reactions, whether given by a sane or an insane 
subject, may, in the vast majority of instances, safely be regarded 
as normal. As to individual reactions, they cannot all be regarded 
as abnormal, but they include nearly all those reactions which are 
worthy of special analysis in view of their possible pathological 
significance. What can be said further of individual reactions, 
whether normal or abnormal, will appear in the second part of 
this contribution. 

{To be continued.) 



48 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



THE FREQUENCEY TABLES. 







1. TABLE 






1 accommodation 


2 dine 


1 kitchen 


1 operating 


1 stable 


3 article 


4 dining 




2 ornament 


36 stand 


1 articles 


26 dinner 


1 lamp 




3 stool 




5 dish 


4 large 


1 parlor 


1 straight 


1 basket 


40 dishes 


1 leaf 


1 pitcher 


1 strong 


9 bench 


1 dissection 


1 leaves 


4 plate 


1 supper 


14 board 


1 dog 


1 library 


1 plates 




7 book 




IS leg 


1 plateau 


1 tablecloth 


5 books 


63 eat 


in legs 


1 polished 


1 tea 


1 boy 


1 eatables 


2 linen 




1 timber 


1 bread 


34 eating 


1 long 


1 refreshments 


2 top 


2 breakfast 




2 low 


3 rest 


1 typewriter 


2 broad 


1 ferns 




3 room 




1 brown 


1 ffte 


1 Mabel 


10 round 


2 use 


1 butter 


5 flat 


2 mahogany 




3 useful 




7 floor 


1 mat 


1 school 


1 utensil 


2 cards 


20 food 


6 meal 


1 serviceable 




1 celery 


1 fork 


4 meals 


2 set 


2 victuals 


1 center 


1 form 


2 meat 


1 shiny 




267 chair 


75 furniture 


1 mess 


3 sit 


1 wagon 


7 chairs 






2 sitting 


1 whist 


1 chemical 


1 glass 


2 nails 


1 slab 


1 white 


57 cloth 




1 napkin 


1 smooth 


1 wire 


1 cockroaches 


9 hard 


1 number 


1 soup 


76 wood 


1 comfort 


1 hat 




1 spiritualism 


1 wooden 


17 cover 


2 home 


1 oak 


6 spoon 


2 work 


1 cutlery 


3 house 


1 object 


2 spread 


1 working 






1 old 


9 square 


2 write 


11 desk 


link 


2. DARK 




6 writing 


6 afraid 


2 cold 


2 fair 


427 light 


1 scare 




28 color 


6 fear 


1 lonely 


1 shades 


1 baby 


1 colored 


1 fearful 


1 lonesome 


2 shadow 


1 bad 


1 colorless 


1 fearsome 


1 lonesomeness 


1 shadows 


1 barks 


1 coon 


2 fright 




1 sky 


76 black 


1 curly 




1 mahogany 


1 sleep 


2 blackness 




1 ghost 


4 man 


1 sleeping 


1 blank 


1 day 


1 ghosts 


1 mice 


1 space 


2 blind 


1 daylight 


6 gloom 


1 midnight 


1 starry 


2 blindness 


1 dead 


11 gloomy 


6 moon 


2 stars 


S blue 


1 denseness 


1 gray 


1 moonlight 


1 stillness 


1 board 


3 dim 


1 green 


1 mysterious 


1 storm 


1 boat 


3 dimness 


1 ground 




1 stumbling 


15 bricht 


2 dingy 




Inice 


1 subject 


4 brightness 


3 dismal 


5 hair 


221 night 


1 sunlight 


4 brown 


1 dog 


1 hall 








1 door 


1 hell 


1 oblivion 


1 thunder 


1 candle 


1 dreary 


1 hole 


1 obscure 


1 tree 


1 cart 


4 dress 


3 horse 




1 twilight 


2 cat 


5 dungeon 


2 house 


1 parlor 




1 cell 


1 dusk 




1 prison 


1 unseen 


fi cellar 


1 dusky 


1 illumination 






1 close 




2 invisible 


5 red 


1 walk 


1 closet 


4 evening 




3 rest 


3 weather 


2 cloud 


1 eye 


1 lamp 


22 room 


9 white 


2 clouds 


2 eyes 


1 lantern 




1 woods 


3 cloudy 











I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



49 







3. MUSIC 






1 accordion 


17 dance 


1 harmonious 


1 noisy 


12 sing 


3 air 


I dances 


45 harmony 


2 note 


1 singer 


1 amuse 


15 dancing 


1 hear 


17 notes 


4S singing 


10 amusement 


1 delierht 


2 heaven 




1 soft 


7 art 


2 delightful 


1 hurdygurdy 


5 opera 


1 softness 


1 attention 


3 discord 


1 hymn 


5 orchestra 


1 solemn 


1 attraction 


1 drama 


1 idealism 


6 organ 


68 song 
6 songs 


6 band 


3 ear 


21 instrument 


2 paper 


2 soothing 


1 bass\ioI 


1 ecstasy 


5 instruments 


1 pastime 


- 95 sound 


7 beautiful 


1 elevating 


1 instrumental 


ISO piano 


2 sounds 


2 beauty 


1 enchantment 




2 pianola 


2 stool 


7 Beethoven 


1 enjoyable 


1 jolly 


1 pitch 


1 strain 


1 bell 


1 enjoyed 


11 joy 


7 play 


2 strains 


1 bird 


13 enjojTnent 


1 joj-ful 


S plajing 


1 string 


1 birds 


5 entertaining 




10 pleasant 


2 study 


1 book 


3 entertainment 


1 lesson 


1 pleasantness 


47 sweet 


2 books 


1 entrancing 


1 light 


5 pleasing 


6 sweetness 


2 box 




1 line 


31 pleasure 


4 symphony 


1 brightness 


1 feeling 


1 liveliness 


1 poem 






1 fiddle 


1 lonely 


4 poetry 


2 talent 


1 captivating 


2 fine 


1 loud 


1 practice 


6 teacher 


1 cats 


1 flowers 


2 love 


4 pretty 


1 teaching 


1 charm 


1 flute 




1 pupils 


1 thought 


1 charms 


1 fun 


1 man 




2 time 


2 charming 




1 meditation 


1 quiet 


3 tone 


2 cheerful 


2 gaiety 


24 melody 




1 town 


2 cheerfulness 


1 gay 


1 Mendelssohn 


1 rack 


2 tune 


1 Chopin 


1 genius 


1 Merry Widow 


1 racket 




1 chord 


2 girl 


1 Mozart 


1 rhvme 


21 violin 


1 chords 


1 gladness 


1 Mr. B. 


2 roll 


2 voice 


1 clarinette 


1 Goethe 


1 Mrs. E. 


1 room 




1 classic 


3 good 


3 musician 




3 Wagner 


2 classical 


1 guitar 


1 mute 


2 sadness 


1 wavT,' 


2 composer 






1 scale 


1 window 


1 company 


Shall 


6 nice 


2 Schubert 


1 words 


2 concert 


5 happiness 


1 nocturne 


1 score 


1 worship 


1 conductor 


2 happy 


16 noise 
4. SICKNKSS 


5 sheet 
1 sheets 


1 Yankee Doodl 


1 affliction 


2 disabled 


2 home 


1 operation 


2 sorry 


1 age 


3 discomfort 


1 horrible 


1 oranges 


1 stomach 


3 ailing 


29 disease 


9 hospital 




2 strength 


2 ailment 


4 distress 




36 pain 


1 suffer 


1 air 


62 doctor 


48 ill 


1 painful 


12 suffering 


1 anxiety 


1 dread 


71 illness 


2 pale 


1 summer 


3 appendicitis 


1 dreariness 


1 incompetence 


7 patient 


2 sympathy 


1 aunt 




1 inconvenience 


1 patients 






1 enjoyed 


1 indisposition 


1 people 


1 terror 


1 baby 


1 ether 


1 inflrmary 


1 person 


1 together 


15 bad 


1 exhaustion 


1 insanity 


7 physician 


20 trouble 


54 bed 




2 invalid 


1 pill 


1 trying 


1 Bertha 


1 family 




1 pills 


6 typhoid 


1 better 


3 father 


1 K. 


1 plague 




1 body 


1 fear 




1 pleasantness 


2 uncomfortable 


1 business 


4 feeble 


1 low 


5 pneumonia 


1 unhappiness 




1 feel 


1 lying 


1 poverty 


1 unhappy 


1 calamity 


1 feeling 






4 unhealthy 


1 care 


9 fever 


2 malady 


1 quiet 


5 unpleasant 


2 child 


1 fevers 


1 man 


1 quietness 


2 unpleasantness 


1 cold 


1 fracture 


8 measles 




11 unwell 


1 condition 


1 fright 


1 medication 


3 recovery 




3 consumption 




29 medicine 


1 relapsing 


1 want 


2 contagious 


1 gloom 


1 melancholy 


1 rheumatism 


1 weak 


1 convalescence 


1 gravel 


1 mine 


1 room 


n weakness 


2 convalescing 


2 grief 


3 misery 




2 wealth 


3 cure 


1 grunting 


3 misfortune 


7 sad 


1 weariness 






3 mother 


9 sadness 


1 weary 


1 danger 


2 hard 




3 serious 


49 well 


115 death 


1 hatefulness 


2 nervousness 


4 severe 


1 white 


1 dietair 


5 headache 


1 neuralgia 


1 sigh 


1 worried 


8 diphtheria 


142 health 


15 nurse 


1 sore 


1 worriment 


1 disability 


4 healthy 


2 nursing 


24 sorrow 





50 



A STUDY OF ASSOCIATION IN INSANITY 



[J"iy 







6. MAN 






2 adult 


1 companion 


1 homely 


6 masculine 


1 self 


1 affection 


1 company 


1 horrible 


1 mason 


4 sex 


1 a^e 


1 coon 


4 horse 


1 mind 


1 shirt 


1 alive 


1 crank 


1 house 


1 might 


1 shoes 


12 animal 


8 creature 


22 human 


1 minister 


1 short 


1 animals 


1 cross 


1 humanity 


1 minor 


1 smoking 


1 animate 




4 husband 


1 misery 


1 stem 


2 appearance 


1 devil 




1 money 


1 stout 




2 doctor 


1 individual 


1 monkey 


1 street 


1 baby 


1 dress 


1 insane 


1 Mr. D. 


32 strength 


2 bad 




1 institution 


1 Mr. H. 


8 strong 


1 beard . 


1 educator 


1 intellectual 


1 Mr. N. 


a sweetheart 


2 beast 


1 existence 


1 intelligent 


3 Mr. S. 




19 beinfT 






1 muscular 


1 Taft 


3 biped 


1 fakir 


1 janitor 




12 tall 


1 blond 


1 false 


1 Joe 


1 N. 


1 thought 


3 body 


1 family 




1 nature 


6 trousers 


44 boy 


15 father 


1 labor 


1 Ned 


1 true 


1 brain 


3 female 


2 laborer 


1 nice 




1 bright 


2 flesh 


7 lady 


3 noble 


1 unfeminine 


1 brightness 


2 form 


11 large 


1 nuisance 


1 use 


3 brother 


1 fraud 


4 life 






1 brotherhood 


1 Fred 


1 light 


1 out 


1 V. 


1 brute 


2 friend 


1 limb 




1 voter 


1 bum 




2 living 


1 papa 




6 business 


1 gentle 


1 lord 


1 passion 


1 walk 




7 gentleman 


1 love 


2 people 


1 wedding 


3 cane 


6 girl 




30 person 


1 whiskers 


1 certain 


1 glacier 


1 machine 


1 pleasure 


5 wife 


2 Charles 


10 good 


1 maiden 


2 policeman 


1 wise 


1(1 child 


1 greatness 


99 male 


1 politician 


,394 woman 


2 children 


1 grown 


1 mammal 


5 power 


' 17 work 


1 Christian 


1 growth 


1 manhood 


1 professor 


1 works 


1 cler^nian 




6 mankind 


1 prosperity 


1 worker 


7 clothes 


1 hair 


1 manliness 


1 provider 


3 working 


2 clothing 


7 hat 


2 manly 






3 coat 


2 help 


1 marriage 


1 Roosevelt 


2 young 


1 comfort 


1 home 


1 married 
6. DEBP 


1 ruler 




3 abyss 


4 darkness 


1 heavy 


1 precipice 


1 story 


1 altitude 


1 dense 


5 height 


4 profound 


1 strong 


1 around 


31 depth 


37 high 




1 study 




1 depths 


32 hole 


1 ravine 


1 sunken 


3 below 


1 diameter 


13 hollow 


1 reaching 


1 surface 


1 beneath 


1 dig 




13 river 


1 swimming 


1 black 


8 distance 


3 large 


1 rocks 




3 blue 


3 ditch 


S length 




1 thick 


1 bottom 


1 doleful 


2 level 


1 safety 


1 thickness 


1 bottomless 


27 down 


4 light 


1 scare 


1 thin 


1 bowl 


1 dread 


18 long 


90 sea 


2 thinking 


1 breath 




51 low 


1 sewer 


14 thought 


2 broad 


1 earth 




1 shade 


2 thoughts 


1 brooding 


1 extension 


2 measure 


1 shady 


1 tranquil 


1 brook 




1 mighty 


^ISO shallow 


1 trench 




2 fall 


1 mind 


1 sharp 




2 cave 


3 falling 


4 mine 


1 ship 


1 under 


1 Cayuga 


3 far 




1 short 




1 chair 


6 fathomless 


3 narrow 


1 sincere 


1 valley 


2 chasm 


1 fear 




2 sink 


2 vast 


1 cellar 


1 full 


93 ocean 


1 sleep 




1 classic 




1 organ 


1 smooth 


1 wading 


1 clear 


1 gloomy 




1 Borrow 


134 water 


1 cliff 


1 good 


1 phUosophy 


2 sound 


44 well 




1 gorge 


1 pit 


6 space 


1 wet 


3 danger 


1 gi-eat 


1 pond 


2 spacious 


12 wide 


6 dangerous 


1 ground 


1 pool 


7 steep 


2 width 


28 dark 











I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



51 



SOFT 



1 apple 


1 dark 


3 gentle 


1 membrane 


3 snap 




1 dough 


1 girl 


2 mild 


7 snow 


7 baby 


6 down 


1 glove 


1 moist 


6 soap 


2 ball 


S downy 


3 good 


2 moss 


1 soup 


1 beautiful 


1 dress 


1 grasp 


15 mud 


22 sponge 


12 bed 


1 drink 


1 grass 


10 mush 


1 sponges 


1 boiled 




3 ground 


1 mushing 


8 spongy 


1 brain 


7 earth 


1 gum 


12 mushy 


1 squash 


4 bread 


1 ease 




4 music 


1 sticky 


1 breeze 


34 easy 


3 hair 




1 strong 


12 butter 


4 egg 


3 hand 


4 nice 


1 substance 




2 eggs 


1 hands 




8 sweet 


1 cake 


1 elastic 


365 hard 


1 palatable 


1 sweetness 


1 candy 


1 eyes 


1 harsh 


2 peach 




1 care 




1 hazv 


2 pear 


8 tender 


1 carpet 


2 feather 


1 head 


63 pillow 


1 texture 


1 cat 


24 feathers 




2 pillows 


1 timid 


1 cement 


1 featherj- 


1 idiot 


8 pliable 


1 tomatoes 


1 clay 


1 feel 




2 plush 


4 touch 


1 clean 


8 feeling 


1 jelly 


4 pudding 




3 cloth 


1 felt 




i putty 


1 uncooked 


1 clothes 


5 fine 


2 kitten 






2 coal 


1 firm 




1 quality 


15 velvet 


1 cold 


3 flabby 


1 large 


3 quiet 


2 voice 


2 color 


1 fleece 


8 light 






2 comfort 


1 flesh 


1 lightly 


3 rubber 


1 wadding 


5 comfortable 


7 fleidble 


2 liquid 




1 warm 


1 comply 


1 floor 


2 loose 


1 sand 


S water 


1 consistency 


1 fluffy 


5 loud 


1 satisfactory 


1 watery 


28 cotton 


2 food 


5 low 


1 seat 


1 wax 


1 crabs 


1 foolish 




10 silk 


3 wet 


2 cream 


1 form 


1 maple 


1 skin 


3 white 


1 creeping 


3 fruit 


1 marshes 


2 slow 


8 wool 


25 cushion 


1 tun 


1 medium 


1 slushy 


1 woolen 




4 fur 


11 mellow 

8. EATING 


27 smooth 


5 yielding 


1 abstam 


1 enjoyable 


2 ice-cream 


1 olives 


2 slow 


1 abstinence 


1 enjoying 


4 indigestion 


1 oranges 


1 slowly 


2 action 


2 enjojTnent 






2 soup 


28 appetite 


1 enough 


1 knives 


2 palatable 


4 starving 


4 apple 


1 etiquette 




3 people 


2 steak 


6 apples 




1 lemons 


3 pie 


2 stomach 


1 assimilation 


3 fast 


2 life 


7 pleasant 


1 stTawt>erries 




5 fasting 


4 live 


1 pleasantness 


2 strength 


1 biting 


1 fattening 


6 living 


10 pleasure 


1 substance 


46 bread 


2 feasting 


1 lobster 


1 plenty 


2 sufficient 


7 breakfast 


1 feed 


1 lobsters 


1 poor 


1 sugar 


1 butter 


5 feeding 


8 lunch 


1 potato 


1 surfeiting 




2 filling 




2 potatoes 


1 sustaining 


4 cake 


1 finishing 


1 masticate 


1 provisions 


2 sustenance 


3 candy 


3 fish 


11 masticating 


1 pudding 


6 swallow 


1 Chacona's 


1 flavor 


5 mastication 




5 swallowing 


1 chew 


1 flesh 


1 matter 


1 quick 




27 chewing 


170 food 


4 meal 


1 quickly 


21 table 


3 chicken 


2 fork 


10 meals 




1 talking 


1 coffee 


1 forks 


11 meat 


2 refreshing 


7 taste 


1 Commons 


8 fruit 


1 meeting 


1 refreshment 


2 tasting 


4 consuming 


4 full 


1 mild 


1 Reisenweber 


3 teeth 


3 cooking 




1 milk 


1 relief 


1 thinking 


2 cream 


1 gluttonish 


1 more 


2 relish 


1 throat 




23 good 


1 motion 


2 resting 


1 tongue 


1 devour 


1 gormandizer 


2 mouth 


1 room 




2 devouring 


1 gratifying 


1 movement 




1 use 


2 diet 




1 much 


1 sandwich 


1 utensils 


1 diets 


3 habit 


1 myself 


12 satisfaction 




1 digest 


a health 




4 satisfied 


3 vegetable 


7 digesting 


1 healthful 


4 necessary 


1 satisfy 


8 vegetables 


1(1 digestion 


1 heartily 


7 necessity 


5 satisfying 


4 victuals 


2 dine 


1 hearty 


3 nice 


1 sick 




1 dining 


2 hot 


1 nourish 


1 sit 


2 want 


31 dinner 


1 house 


2 nourisfling 


1 sitting 


1 water 


6 drink 


19 hunger 


11 nourishment 


1 sleep 


1 watermelon 


166 drinking 


44 hungry 




17 sleeping 


2 well 


1 dyspepsia 








1 work 



52 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



1 abrasion 

4 Adirondacks 

2 air 

3 Alleghany 
6 Alps 

2 altitude 
1 attractive 
1 automobile 

1 Bald 

1 beautiful 

2 beauty 
2 big 

1 Blanc 
1 Bluff 
1 Breckenridge 

1 camping 

5 Catskills 

2 cliff 
1 cliffs 

1 Clifton 
9 climb 
27 climbing 
1 close 

3 clouds 
1 cone 

5 country 
1 crevice 

1 descend 

2 descending 
1 desert 



15 abode 
1 alley 

3 apartment 

1 background 

74 bam 

1 Bay Ridge 

2 beautiful 
1 Belknap 

4 big 

1 blinds 

3 boards 

2 boat 

1 box 
23 brick 

5 bricks 

2 brown 
2 build 

75 building 
2 bungalow 

8 cabin 
1 camp 

1 carpenter 
1 carpet 

4 castle 
1 cattle 

1 cellar 

2 chair 

1 chamber 
1 chicken 

5 chimney 

1 church 

2 city 

2 clean 
1 closed 
1 college 

9 comfort 
1 comforts 

3 comfortable 
1 contractor 



1 dirt 

1 distance 

1 ditch 

3 earth 
9 elevation 

1 fear 

1 field 

1 Flashman 

1 foliage 

1 fountain 

I Galeton 
1 geography 
1 grand 

3 grandeur 
1 granite 

1 grass 
1 great 

4 green 

1 ground 

1 heath 
73 height 

2 heights 
246 high 

1 highlands 

2 highness 
184 hill 

32 hills 
2 hilltop 
1 hilltops 



9. MOUNTAIN 

2 hilly 

1 Himalaya 

5 hollow 

1 Holyoke 
1 home 
1 horse 

1 Hudson 

2 huge 

1 impressive 
1 incline 
1 island 

1 Kipling 
1 knoll 

8 lake 

6 land 

1 landscape 
4 large 
1 level 

1 lofty 

2 low 

1 lowland 

1 Monodonack 
1 mound 
1 Mount h-j' 
1 Mount Rear- 

sarge 
1 Mount McKin- 

ley 



1 corridor 
42 cottage 
3 cover 
1 covering 

1 dark 

1 den 

2 dog 

1 domestic 
1 domicile 
16 door 
1 doors 

3 dwell 

68 dwelling 

1 enclosure 
1 erection 

4 family 

1 fancy 

2 farm 

1 farmer 

1 fence 

1 field 

1 fire 

1 floor 

1 form 

1 foundation 

5 frame 

1 friends 
1 furnace 
1 furnishing 
11 furniture 

10 garden 
1 grandmother 

1 great 

2 green 

3 ground 
1 grounds 



1 Mount Pleasant 
1 Mount Shasta 

1 Mount Wilson 

2 object 

1 Owl's Head 

16 peak 

1 peaks 

1 pictures 

1 Pike's Peak 

1 pines 
11 plain 

1 plateaus 

3 pleasure 
1 pointed 

1 railway 
3 range 
1 ranges 

5 river 
10 rock 

6 Rockies 
IS rocks 

5 rocky 
1 rough 

1 scene 
3 scenery 
1 sea 
1 seas 
1 seashore 



10. HorsB 

1 habitable 
5 habitation 

1 happiness 

2 height 

3 high 

3 hill 
103 hume 

1 homeless 

4 hospital 
1 hot 

5 hotel 

1 hovel 

2 hut 

1 inhabitant 
1 inhabited 
1 inmates 
1 into 

1 joy 

10 land 

1 lake 

24 large 

3 lawn 

1 lemon 

1 Leon i a 

2 life 
33 live 
19 living 
IS lot 

1 lots 

3 lumber 

2 man 

14 mansion 
1 material 
1 mine 
1 mortgage 
1 Mountain 
House 



1 object 
1 old 
1 ours 

1 palace 
1 painting 

1 Pasadena 

11 people 

2 piazza 
1 picture 
6 place 

1 pleasant 

3 pretty 

1 property 

3 protection 

4 red 

1 refuge 
19 residence 

2 resident 
1 restful 

1 road 

12 roof 
9 room 
8 rooms 

1 Sage 

2 school 
1 sea 

1 shanty 

5 shed 
22 shelter 

2 sky 

2 small 

1 spacious 
4 square 

3 stable 



1 shadows 
1 shooting 

1 size 

2 sky 

1 slope 
10 snow 
12 steep 

1 steepness 

2 stone 

1 stones 

2 stream 

4 summit 

2 Switzerland 

1 tall 

1 Terrace 

5 top 

2 tree 
17 trees 



1 up 

2 vale 
9^) valley 

5 valleys 

1 Vermont 

2 view 

2 volcano 

1 Washington 
5 White 
1 wood 

3 woods 



1 star 
1 steps 
7 stone 

1 stoop 

2 store 

7 street 

8 structure 

1 tabernacle 
1 table 
1 tall 
1 telescope 

1 tenant 

2 tenement 

3 tent 

1 timber 
5 top 

1 town 

2 tree 
1 trees 

1 tumbler 

2 villa 

1 village 

1 walls 

3 warm 
1 wealth 
1 well 

9 white 

1 Whittier 
1 wide 
1 willow 
9 window 
5 windows 
31 wood 
1 wooden 
1 workman 
1 worship 

10 vard 



I9IO] 


GRACE HELEN 


KENT AND A. 
11. BLACK 


J. ROSANOI 


^F S 


1 agreeable 


36 darkness 


2 hair 


1 obscure 


2 somber 




■1 death 


3 hat 


1 orange 


1 soot 


8 blue 


1 dense 


1 heavy 




4 sorrow 


3 board 


1 desolate 


1 hog ■ 


4 paint 


1 space 


2 book 


2 dirty 


1 horror 


1 paper 


1 spectrum 


2 bright 


1 disagreeable 


5 horse 


1 pen 


1 stocking: 


1 buggy 


1 dislike 




2 pink 


1 stockings 




4 dog 


1 impenetrable 


1 pipe 


1 suit 


8 cat 


1 domino 


14 ink 


1 pit 




1 chair 


29 dress 






1 table 


1 charcoal 


2 dye 


1 lack 


1 radiator 


1 tar 


17 cloth 




12 light 


4 red 


1 terror 


4 clothes 


1 earth 




1 ribbon 


1 tie 


1 cloud 


1 ebony 


1 mammy 


1 robe 




1 clouds 




2 man 




1 umbrella 


2 cloudy 


1 face 


1 Mrs. B. 


1 sad 




3 coal 


2 fear 


2 mournful 


2 sadness 


1 velvet 


3 coat 


1 figure 


17 mourning 


1 sack 




128 color 


1 flecked 


1 mud 


I shady 


2 wall 


1 colored 


1 floor 




2 slieep 


1 water 


3 colorless 


1 funeral 


7 negro 


4 shoe 


339 white 


1 coon 




1 negroes 


1 shoes 


1 wonder 


2 crepe 


2 gloomy 


6 nigger 


1 sign 


1 wood 


1 curtain 


1 gown 


51 night 


2 skirt 






2 gray 


1 nothing 


1 skj. 


2 yellow 


172 dark 


7 green 









53 



9 animal 


1 animals 


1 appetite 


1 Australia 


1 baa 


97 beef 


1 bony 


1 breakfast 


15 broth 


1 brown 


2 butcher 


2 calf 


1 cattle 


3 cheap 


34 chop 


33 chops 


2 cow 



1 delicious 

6 dinner 

2 disagrreeable 

1 dish 

2 dislike 

1 disliked 

14 eat 

7 eatable 
10 eating 

7 fat 

2 field 
10 flesh 

1 flock 

30 food 

1 fork 

1 fowl 



12. MUTTON 

1 goat 
9 good 

1 grass 

2 grease 

1 greasy 

2 ham 

1 hate 

2 head 

1 horrid 

1 indigestion 

1 knife 

121 lamb 

2 lambs 
5 leg 



1 Mary 


1 soft 


257 meat 


2 soup 


1 mouse 


1 stale 


1 muttonhead 


3 steak 




2 stew 


2 nice 


2 strong 


1 old 


4 table 




6 tallow 


1 pastures 


3 tender 


1 peas 


1 thinking 


2 pig 


6 tough 


3 pork 






1 uncle 


1 rare 




4 roast 


30 veal 




1 vegetables 


1 sauce 


1 vegetarian 



204 sheep 
1 smell 



i wool 



54 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



13. COMFORT 



1 agrony 


1 driving 


1 justice 


1 please 


11 solid 


1 annoyance 






77 pleasure 


3 solitude 




165 ease 


1 kindness 


1 plentiness 


2 soothing 


Ibad 


11 easiness 




1 plenty 


6 sorrow 


42 bed 


61 easv 


1 lamp 


1 Polly 


1 speak 


4 blanket 


1 eating 


2 laziness 


1 post 


1 spirit 


1 book 


1 enjoying 


1 lazy 




1 spread 


1 books 


6 enjojTnent 


6 leisure 


6 quiet 


1 suffering 






1 less 


1 quietness 


1 sweet 


1 canoe 


1 feather 


1 life 


7 quilt 


1 swing 


4 care 


1 feeling 


1 like 






31 chair 


2 fireplace 


2 living 


1 rain 


2 table 


1 cheer 


2 fireside 


1 loneliness 


1 relief 


1 taken 


1 children 


1 friends 


6 lounge 


53 rest 


1 tea 


1 cloth 




1 luxurious 


1 restful 


1 thankfulness 


4 comfortable 


1 God 


23 luxury 


1 restfulness 


1 tired 


1 comforter 


5 good 




5 resting 


1 trials 


2 consolation 


1 goodness 


1 man 


1 rich 


1 trouble 


1 console 


1 great 


1 mansion 


3 rocker 




1 consolinir 


1 grief 


1 miserable 




1 uncomfort 


2 content 




9 misery 


1 safety 


10 uncomfortable 


4 contentment 


7 hammock 


9 money 


1 salary 


3 imeasiness 


2 convenience 


60 happiness 


3 mother 


4 satisfaction 


3 uneasy 


1 cozy 


17 happy 




3 satisfied 


1 unrest 


9 couch 


2 hard 


1 neatness 


1 security 


1 unwell 


1 cover 


7 hardship 


4 nice 


1 settled 




1 covering 


1 healing 


1 none 


Isick 


6 warm 


4 cushion 


15 health 


2 nurse 


3 sickness 


4 warmth 


1 cushions 


3 help 




1 sit 


6 wealth 




63 home 


4 pain 


4 sitting 


3 well 


1 davenport 


4 house 


2 palace 


10 sleep 


1 well-being 


1 death 


1 household 


1 patient 


1 slippers 


1 wine 


1 delightiui 




12 peace 


1 slumber 


1 wish 


2 desirable 


IT 


1 people 


1 smoke 


1 woman 


24 discomfort 


1 idleness 


2 pillow 


1 smoking 


1 wool 


1 disease 


1 ill 


1 pipe 


5 sofa 


1 work 


1 displeasure 




1 playing 


2 soft 




4 distress 


9 joy 


9 pleasant 
14. HAND 


1 solace 


lye 


2 anatomy 


11 feel 


2 instrument 


1 narrow 


1 shapely 


63 arm 


5 feeling 




2 necessity 


1 shop 


2 arms 


35 feet 


1 jewel 


1 nice 


1 shoulder 




2 fellowship 




1 nimble 


4 skin 


1 ball 


39 finger 


1 kindness 


1 nose 


1 slim 


3 beautiful 


83 fingers 


1 knife 




8 small 


3 black 


1 fist 


1 knitting 


1 object 


1 soap 


1 bleeding: 


19 flesh 




4 organ 


8 soft 


48 body 


204 foot 


1 labor 




1 something 


1 bone 


1 form 


1 large 


5 palm 


1 sore 


1 bones 


1 formation 


4 leg 


1 part 


6 strength 


1 bus}' 


1 friend 


1 legs 


2 paw 


3 strong 




1 friendship 


1 lemon 


1 pencil 


1 support 


2 cards 


1 fruit 


2 life 


1 perfect 


1 system 


1 clean 




48 limb 


10 person 




1 clock 


1 give 


1 limbs 


1 piano 


1 table 


1 convenience 


20 glove 


1 long 


1 pen 


1 thread 


1 cradle 


5 gloves 


1 love 


3 power 


9 touch 


1 cunning 


1 good 




3 pretty 


2 two 




8 grasp 


2 machine 


1 purity 




1 dexterity 


1 greeting 


1 maid 




12 use 


1 diligence 


S grip 


3 man 


1 reach 


24 useful 


1 dissecting 




1 manipulation 


1 rest 


4 usefulness 


1 do 


1 handle 


14 member 


11 right 




2 doing 


3 handy 


1 mind 


23 ring 


1 watch 


1 dog 


1 hard 


1 mine 


2 rings 


1 woman 




1 head 


4 mouth 




49 work 


1 ear 


2 heart 


1 move 


1 satisfaction 


15 white 


1 elbow 


6 help 


4 muscle 


1 servant 


4 wrist 


6 extremity 


2 helper 




2 sew 


3 write 




1 helping 


2 nail 


2 sewing 


11 writing 


V face 


3 hold 


1 nails 


9 shake 




1 fat 


1 holding 

2 human 


1 name 


1 shape 


1 you 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



55 







15. SHORT 






2 abbreviated 


1 down 


1 lake 


1 petticoat 


1 strong 


1 age 


1 drawn 


2 large 


1 pin 


1 stubborn 


2 arm 


3 dress 


2 leg 


Ipity 


9 stubby 




2 dumpy 


IS length 


1 plant 


4 stumpy 


' 1 baby 


11 dwarf 


1 lesson 


1 plants 


1 stunned 


1 beach 


1 dwarfs 


1 lessons 


1 pony 


1 stunted 


1 beam 




5 life 


2 post 


1 sufficient 


1 board 


2 easy 


15 little 


2 pygmy 


1 sura 


3 boy 


1 elongated 


1 line 




1 sweet 


1 brevity 


1 extension 


1 lived 


8 quick 




1 brick 




270 long 


1 quickly 


168 taU 


7 brief 


4 fat 


11 low 




6 thick 


1 broad 


1 finger 


1 lowly 


1 road 


1 thin 


1 build 


1 flowerpot 




1 round 


8 time 




2 foot 


20 roan 




1 tiny 


1 C. 


2 friend 


3 measure 


1 session 


1 Tom Thumb 


1 cake 




1 measurements 


1 shallow 


1 tree 


1 chair 


11 girl 


2 medium 


1 sister 




1 change 


1 good 


1 midget 


5 size 


1 unpleasant 


4 child 


1 grandmother 


1 millimeter 


1 skirt 


1 useless 


1 children 


5 grass 


1 minus 


1 sleek 




1 clock 




1 Miss K. 


1 slight 


1 vacation 


1 cloth 


2 hair 


1 money 


1 slightly 




1 comfort 


1 happiness 


1 mother 


136 small 


1 waisted 


1 compact 


13 height 


6 myself 


1 space 


3 walk 


1 cut 


4 high 




2 speech 


1 want 


1 cylinder 


1 hour 


1 name 


1 square 


2 wanting 




3 hours 


1 narrow 


1 staccato 


1 water 


1 dainty 




1 near 


2 statiu-e 


1 weU 


4 day 


5 inch 


1 needle 


2 stem 


1 wide 


2 deficient 




1 not 


8 stick 


6 woman 


1 dimension 


2 journey 




2 stop 


1 wood 


1 diminiature 




1 out 


1 story 


1 worm 


2 diminutive 


1 Karl 




24 stout 




1 disagreeable 




6 pencil 


1 strawberries 


1 you 


10 distance 


1 lacking 


3 people 


2 street 




1 dot 


4 lady 


15 person 
16. FRUIT 


1 string 




2 acid 


1 easy 


3 health 


25 orange 




2 appetite 


62 eat 


3 healthy 


20 oranges 


1 salad 


157 apple 


33 eatable 


1 home 


6 orchard 


5 seed 


102 apples 


15 eatables 




1 outcome 


1 sickness 


1 article 


35 eating 


1 Italians 




4 sour 




1 edible 


1 invigorating 


2 palatable 


1 south 


1 bake 


1 egffs 


1 jam 


17 peach 


1 spring 


11 banana 


2 enjoyment 


6 juice 


32 peaches 


1 stalk 


S bananas 




6 juicy 


24 pear 


1 stand 


7 berries 


1 flgs 




11 pears 


1 stems 


1 berry 


1 fish 


1 knife 


1 picking 


1 store 


1 blackberries 


1 flesh 




1 pie 


2 strawberries 


2 bread 


3 flower 


2 lemon 


2 pineapple 


1 strawberry 




3 flowers 


1 liked 


1 plant 


2 summer 


2 cake 


1 fond 


1 love 


1 plants 


1 swallow 


1 can 


22 food 


3 luscious 


2 pleasant 


24 sweet 


1 candies 


1 fresh 


2 luxury 


1 pleasure 


1 sweets 


3 candy 






2 plenty 




2 cherries 


2 garden 


4 meat 


2 plum 


3 table 


2 cheny 


24 good 


1 medicine 


2 produce 


5 taste 


1 country 


2 grain 


1 melon 


1 prune 


35 tree 


1 currants 


4 grape 
14 grapes 


1 milk 


1 raspberries 


27 trees 


1 dainty 


1 grapefruit 


1 nourishing 


1 raspberry 


75 vegetable 


2 delicacy 


1 green 


2 nourishment 


1 red 


2S vegetables 


9 delicious 


1 groves 


5 nice 


1 result 




1 desire 


1 grow 


2 nutritious 


9 ripe 


1 watermelon 


1 digest 


1 grows 


2 nuts 


1 ripeness 


1 wine 


1 digestion 


2 growth 









S6 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



17. BUTTERFLY 



1 air 


6 cocoon 


20 flying 


1 lilies 


1 soul 


1 airiness 


1 cocoons 




1 little 


1 sparrow 


2 airy 


4 collection 


1 gaudy 




1 speckled 


24 animal 


12 color 


1 gauze 


1 meadows 


9 spider 


2 animals 


S colors 


2 gay 


1 metamorphosis 


2 spotted 


2 ant 


3 colored 


2 girl 


4 miller 


5 spring 




2 country 


2 gnat 


1 monarch 


17 summer 


1 beast 


1 cricket 


3 golden 


3 mosquito 


1 sun 


24 beautiful 




1 good 


1 motion 


f) sunshine 


20 beauty 


1 daisy 


2 grace 


30 moth 


1 swallow 


31 bee 


1 dish 


1 graceful 


1 moths 


1 sweet 


4 boes 


1 dove 


1 grass 


1 mountains 


1 swift 


5 beetle 


1 dress 


5 grasshopper 


1 mourning cloak 




64 bird 


1 dust 


2 grasshoppers 




1 temporary 


10 birds 




5 grub 


2 nature 


1 tree 


2 black 


1 eagle 




6 net 


1 two 


1 blossom 


1 ease 


1 handsome 


1 nets 




1 blue 


1 ephemeral 


1 happy 


2 nice 


1 useless 


2 bread 




1 high 






1 bright 


1 fairy 


1 horse 


1 orange 


2 vanity 


2 brilliant 


2 field 


1 human 


1 outdoors 


1 variegated 


1 brown 


1 fields 








1 bush 


1 firefly 


1 idler 


1 pancake 


11 wasp 


3 butter 


6 flies 


261 insect 


1 pig 


2 white 


fi buttercup 


2 flight 


2 insects 


2 pigeon 


1 wind 


11 bug 


1 flippant 




1 plumage 


11 wing 


1 bugs 


1 flittering 


1 Japanese 


1 powder 


31 wings 


1 bumblebee 


1 flitting 




Za pretty 


] word 




1 flits 


1 kite 




12 worm 


1 cabbage 


IS flower 




1 red 


2 worms 


37 caterpillar 


12 flowers 


1 lady 






1 caterpillars 


2 flutter 


3 lepidoptera 


2 small 


37 yellow 


1 chase 


1 fluttering 


5 light 


1 snakes 




3 chrysalis 


44 fly 


2 lightness 


1 snare 





18. SMOOTH 



2 apple 


3 face 


1 kind 


5 pleasant 


2 small 




1 fair 




1 pleasing 


1 snake 


1 ball 


1 feeling 


1 lake 


1 plum 


79 soft 


1 basin 


8 fine 


2 lawn 


5 polished 


1 softness 


2 bed 


2 finished 


1 lena 


1 pressed 


1 sphere 


9 board 


14 flat 


52 level 




1 stone 


1 butter 


2 flexible 


1 lightly 


1 quality 


2 straight 




35 fioor 


3 lovely 


1 queer 


1 street 


4 calm 


1 folded 






1 stroke 


1 carpet 


2 fur 


1 machinery 


1 razor 


25 surface 


1 character 




1 mahogany 


2 river 




1 cheek 


68 glass 


10 marble 


4 road 


20 table 


1 chip 


4 glassy 


1 mercury 


1 roads 


1 thin 


1 circua 


1 glazed 


1 mild 


2 roof 


1 thought 


2 clean 


3 glide 


1 mirror 


277 rough 


1 tidy 


3 clear 


1 gliding 


1 molasses 


2 round 


1 tomato 


3 cloth 


11 glossy 




1 rubber 


1 tongue 


1 clothes 


2 good 


1 narrow 


1 rugged 


4 touch 


2 coarse 


1 goods 


4 nice 


1 rule 


1 tranquil 


1 coat 


1 grand 


1 nicely 


1 running 




1 country 


3 grass 






2 uneven 


1 course 


1 grease 


1 oyster 


1 sailing 




2 cream 


4 ground 




1 sandpaper 


29 velvet 


1 cube 




1 paint 


2 satin 


1 velvety 




3 hair 


9 paper 


1 sea 


1 very 


1 deceitful 


2 hand 


2 paste 


1 shape 




1 deep 


41 hard 


1 pat 


1 sharp 


S wall 


1 desk 


1 harmonious 


1 path 


1 shave 


1 walls 


1 done 


4 harsh 


1 pebble 


4 shiny 


10 water 


1 dry 




1 person 


4 Bilk 


1 wave 




14 ice 


1 piano 


1 silken 


1 window 


2 ease 


13 iron 


1 placid 


5 skin 


3 wood 


12 easy 


1 ironing 


17 plain 


2 sleek 


1 work 


SO even 


1 ivory 


23 plane 


3 slick 


1 worm 


1 evenness 




1 planed 


4 slippery 


1 wrinkled 
1 wrinkles 



ipio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



57 



19. COMMAND 



1 abilitv 


1 dislike 


1 harshly 


12 obedience 


1 something 


1 ar-t 


27 do 


1 haughtv 


2 obedient 


3 speak 


1 acting 


3 doing 


1 head 


230 obey 


1 spoken 


1 anger 


2 domineer 


1 him 


1 obeyed 


1 stamina 


1 answer 


2 domineering 


1 holy 


3n officer 


1 statement 


1 anything 


2 done 


1 honorable 


1 only 


7 stem 


1 appeal 


2 don't 


1 horse 


171 order 


3 strength 


1 appearance 


1 door 




2 ordering 


1 strict 


16 army 


2 drill 


1 I 


9 orders 


3 strong 


1 arrogance 


1 driver 


1 immediately 




1 stubborn 


2 ask 


5 duty 


3 imperative 


1 parents 


1 superintend 


2 asking 




4 imperious 


1 peace 


1 superior 


1 athletics 


1 earnestness 


1 independent 


2 people 


1 supervisor 


3 attention 


1 easy 


1 insist 


2 peremptory 


1 surly 


14 authority 


1 eat 


1 instant 


1 perfect 


1 surrender 




1 effort 


1 institution 


1 person 




1 baseball 


1 employ 


2 instruct 


1 plead 


2 talk 


1 Bible 


1 emDloyees 


1 instruction 


1 policeman 


1 teach 


1 bid 


1 enforce 


1 intelligence 


10 power 


14 teacher 


6 boss 


1 entreat 




2 powerful 


1 teachers 


Iboy 


7 entreaty 


1 judge 


1 praise 


1 teaching 




1 exclamation 




1 proper 


15 tell 


7 captain 


1 exertion 


1 knowing 




1 telling 


2 charge 


1 experience 




1 question 


3 temper 


2 chief 




1 labor 


1 quick 


1 temperament 


1 church 


1 father 


1 language 




1 thee 


1 combine 


1 firm 


2 law 


2 refuse 


1 them 


1 combined 


1 forbid 


1 laziness 


1 regiment 


2 think 


5 come 


7 force 


2 lead 


1 reply 


1 thinking 


5 commander 


1 forced 


1 leader 


2 reprimand 


1 thoughtfulness 


2 commandment 


1 foreman 


1 lieutenant 


11 request 


1 threat 


2 company 




2 listen 


5 respect 


2 told 


1 compel 


1 gain 


2 loud 


1 respond 




8 control 


4" general 


1 love 


1 retreat 


1 uncomfortable 


1 cross 


1 gentleness 




3 right 


1 upright 




1 gently 


1 madam 


2 rule 




1 dare 


1 Germany 


9 man 


1 ruling 


6 voice 


IS demand 


1 give 


2 master 


1 running 


1 vow 


1 demanding 


25 go 


1 masterful 






2 desire 


1 God 


3 military 


1 say 


1 wagon 


2 determined 


1 God's 


2 mind 


1 saying 


1 wife 


3 dictate 


2 good 


1 mother 


2 school 


3 will 


1 dictatorial 


1 govern 


1 move 


1 severe 


1 willing 


2 dignity 


1 grand 


1 must 


1 Shalt 


2 words 


2 direct 






1 ship 


2 work 


1 disability 


4 halt 


1 noble 


16 soldier 


1 wrong 


2 discipline 


4 harsh 


1 nuisance 


6 soldiers 





20. CHAIR 



3 you 



4 arm 


1 cushions 


1 idleness 


1 people 


S6 sitting 


4 article 




1 implement 


3 person 


1 size 




9 desk 




1 place 


6 sofa 


1 back 




1 joiner 


1 placed 


5 soft 


1 beauty 


7 ease 




1 plant 


1 spooning 


1 bed 


6 easy 


3 large 


1 platform 


1 stand 


13 bench 




7 leg 


1 pleasant 


3S stool 


1 book 


1 fatigue 


U legs 


1 pleasure 


1 stoop 


1 boy 


W floor 


3 lounge 


1 posture 


1 study 


2 broken 


1 feet 


3 low 




1 support 


4 brown 


1 foot 


1 lunch 


1 reading 




1 bureau 


1 footstool 




45 rest 


191 table 




1 form 


3 mahogany 


3 resting 


1 tables 


3 cane 


S3 furniture 


1 massive 


17 rocker 


1 talk 


1 caning 




1 mission 


15 rocking 


1 teacher 


1 careful 


1 Governor 


j Morris 


9 room 


1 timber 


1 carpet 


Winthrop 


1 myself 


2 rounds 


1 tool 


1 cart 






1 rubber 




1 color 


1 hair 


2 necessity 


3 rung 


1 upholstered 


21 comfort 


hard 






1 upholstery 


S comfortable 


2 hickory 


2 oak 


127 seat 


2 use 


3 convenience 


4 high 


1 object 


5 seated 


3 useful 


5 couch 


2 home 


1 occupy 


2 seating 




1 crooked 


3 house 


1 office 


3 settee 


1 white 


12 cushion 






107 sit 


49 wood 
6 wooden 



S8 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







21. S'WEKT 






5 affreeablo 


1 dinner 


1 hunger 


33 nice 


1 sharp 


1 appetizing 


1 dog 


1 Huyler's 




1 sickish 


11 apple 


1 dreams 




1 orange 


2 sixteen 


3 apples 


1 E. 


1 insipidity 


2 oranges 


6 soft 

1 soothing 


3 beautiful 


2 eat 


2 kiss 


9 palatable 


301 sour 


60 bitter 


1 elegant 




3 peach 


1 stuff 


1 black 


1 eyes 


1 limited 


1 peaches 


224 sugar 


1 breath 




1 lovely 


3 perfume 


2 SJTUp 




1 face 


1 loving 


2 pie 




1 candies 


2 flavor 


2 low 


1 plausible 


57 taste 


82 candy 


2 flower 




31 pleasant 


4 tasteful 


1 cherries 


3 flowers 


1 Mary 


4 pleasing 


2 tasting 


1 child 


1 food 


1 mellow 


1 pleasurable 


11 tasty 


3 chocolate 


1 fresh 


1 melody 


1 pleasure 


1 tea 


1 chocolates 


9 fruit 


2 milk 


1 plum 


2 toothsome 


2 clean 




1 molasses 


1 preserves 




1 confectionery 


1 gentle 


1 mouth 




1 ugly 


1 cream 


6 girl 


8 music 


1 quality 


1 unpleasant 


1 cunning 


26 good 


1 musty 


1 saccharine 


1 very 


7 delicioua 


2 harsh 


1 name 


3 salt 


1 voice 


1 dessert 


12 honey 


1 nausea 


1 salty 


1 wholesome 



2a. IVHISTLR 



1 act 


1 crow 


5 holler 


1 person 


1 sounds 


1 action 


2 cry 


1 hollow 


1 piercing 


3 steam 


7 air 


1 cuckoo 


4 horn 


7 pipe 


1 steamboat 


3 alarm 




1 humming 


2 pleasure 


1 stick 


1 annoyance 


3 dance 




1 police 




2 attention 


1 dear 


6 instnmient 


6 policeman 


4 talk 


1 automobile 


1 disagreeable 




1 postman 


1 telephone 




1 distant 


2 joy 


1 postman's 


1 throat 


1 bad 


7 dog 




1 pretty 


7 tin 


2 bell 


1 drink 


1 lad 


4 pucker 


1 tool 


15 bird 


1 dumb 


3 laugh 




1 top 


3 birds 




1 letter-carrier 


1 quiet 


4 toy 


1 blast 


1 ear 


5 lips 




6 train 


5 blew 


3 echo 


5 locomotive 


2 racket 


1 tree 


95 blow 


1 effort 


3 long 


1 report 


2 trumpet 


6 blowing 


15 engine 


27 loud 


1 running 


IS tune 


2 blows 




1 low 






2 boat 


2 factory 




1 scream 


1 umpire 


66 boy 


3 fife 


1 man 


1 screech 


1 unpleasant 


5 hovs 


1 fingers 


1 raaah 


5 sharp 




1 breath 


3 fire 


1 melodioud 


4 shout 


1 vibration 


1 bright 


S flute 


1 metal 


1 shrieking 


3 voice 


1 brother 


Ifly 


2 miU 


26 shrill 




1 buzzing 


2 Franklin 


1 mine 


1 shrillness 


1 warble 




2 tun 


1 mocking 


3 signal 


1 warning 


26 call 


1 fimny 


27 mouth 


1 sang 


1 whisper 


2 calling 




44 music 


75 sing 


1 whispering 


2 cars 


1 Galton 




4 singing 


8 willow 


1 cent 


Igirl 


3 nice 


1 soft 


10 wind 


3 chain 




1 nightingale 


1 softly 


1 wood 


1 chUdren 


1 habit 


173 noise 


12 song 


1 wooden 


1 clean 


3 happiness 


3 noisy 


1 songs 


1 work 


1 clear 


1 harmony 


1 note 


1 sorority 




1 come 


1 harsh 


1 notes 


103 sound 


lyeU 


1 conductor 











I9I0] 



GRACE HELEN KENT AND A. J. ROSANOFF 



59 



23. \^OMAN 



2 adult 


1 delicate 


2 grand 


3 lovely 


5 short 


1 affinity 


1 delightful 


1 grandmother 


1 loving 


4 sister 


1 aeed 


1 develop 


2 great 




3 skirt 


2 angel 


1 dignity 




1 Mabel 


3 skirts 


1 appearance 


1 dinner 


9 hair 


1 maid 


2 slender 


1 appreciating 


1 domestic 


4 handsome 


1 majesty 


1 small 


1 artificial 


28 dress 


5 hat 


292 man 


1 softness 




4 dresses 


1 hats 


2 mankind 


1 spiritual 


1 baby 


1 dressmaker 


1 helper 


2 marriage 


2 stout 


1 Barnard 


1 dust 


3 helpmate 


2 married 


2 style 


17 beautiful 




1 her 


2 mate 


1 suffrage 


7 beauty 


1 Edna 


3 home 


1 modesty 


2 sweet 


9 being 


1 endurance 


1 honor 


30 mother 


2 sweetness 


1 Bible 


2 Eve 


2 house 


1 Mrs. S. 


1 sweetheart 


1 biped 


1 eyes 


1 housekeeper 


1 myself 




3 body 




1 housewife 




1 talk 


1 bonnet 


9 fair 


11 human 


1 nature 


7 tall 


3 bOT 


3 fashion 


2 humanity 


1 necessity 


1 teacher 


1 bright 


134 female 




3 nice 


1 temporary 




10 feminine 


1 inexplicable 


1 noble 


1 truth 


1 capability 


2 fiesh 


1 individual 


1 nurse 




1 cat 


1 figure 


1 intellect 




1 uneasy 


1 character 


2 fine 


1 interesting 


1 old 


1 use 


45 child 


1 freedom 








2 children 


3 friend 


5 kind 


1 palmist 


2 virtue 


2 clean 




1 kindness 


1 parasol 




1 clever 


1 genteel 




1 people 


1 waist 


6 clothes 


5 gentle 


2 labor 


1 perfection 


1 walks 


1 clothing 


1 gentleness 


41 lady 


17 person 


1 weak 


2 comfort 


59 girl 


4 large 


1 petticoats 


2 weakness 


1 companion 


3 girls 


1 leader 


3 pleasure 


15 wife 


4 creature 


1 goddess 


1 liar 


10 pretty 


1 will 


1 cross 


4 good 


1 living 


1 purity 


1 womanhood 




1 goodness 


1 lovable 




2 work 


1 dear 


1 gown 


5 love 


1 rib 




1 deceit 


3 grace 


1 loveliness 




5 you 




2 graceful 




5 sex 


4 young 



24. COIiD 



1 activity 


1 darkness 


2 head 


1 overcoat 


1 sleighing 


2 agreeable 


5 dav 


1 hearted 




1 slow 


4 air 


1 death 


37 heat 


1 pain 


1 sneezing 


1 arctic 


1 degree 


151 hot 


1 Peary 


45 snow 


4 atmosphere 


6 disagreeable 




2 penetrating 


1 snuffles 


1 autumn 


8 discomfort 


114 ice 


1 pleasant 


1 stone 




3 dreary 


1 ice-cream 


1 pressure 


1 storm 


2 bad 




1 irritating 




3 stove 


4 bitter 


1 feel 




1 quiet 




1 bracing 


10 feeling 


1 January 




1 temperate 


1 breezy 


1 feet 




1 raw 


8 temperature 


1 brisk 


1 Finland 


1 latitude 


1 refrigerator 


1 thermometer 


1 bum 


6 fire 


1 lemonade 


1 rhinitis 


1 touch 




1 fold 


2 light 


1 room 




9 chill 


7 freeze 




1 running 


10 uncomfortable 


30 chilly 


23 freezing 


2 man 


1 rough 


4 unpleasant 


2 clothes 


2 frigid 


1 medicine 






1 clothing 


9 frost 


1 misery 


1 sensation 


166 warm 


1 coal 


4 frozen 


1 mushroom 


5 severe 


6 warmth 


5 coat 


1 fuel 




3 sharp 


7 water 


2 comfort 


2 furs 


1 nature 


6 shiver 


49 weather 


1 comfortable 




1 naughty 


2 shivering 


iwell 


1 comfortless 


1 grippe 


1 near 


1 shivers 


1 white 


5 cool 


1 gloomy 


1 never 


1 shivery 


5 wind 


5 cough 




1 night 


1 shrivel 


1 windy 


2 cure 


1 ham 


1 numb 


1 shudder 


120 winter 




1 hands 


1 numbness 


4 sick 


1 wraps 


2 damp 


2 hard 




6 sickness 




4 dark 






1 skating 


2 zero 



6o 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







25. SLOW 






1 action 


1 decrease 


1 indecision 


1 pace 


1 subway 


1 ace 


2 delay 


1 insect 


1 papa 


27 sure 


1 an^er 


I deliberate 


2 invalid 


8 person 


S swift 


2 animal 


2 dilatory 


1 irritating 


2 Philadelphia 


1 swing 


1 ant 


1 distance 




1 poke 




1 anxiety 


1 dizzy 


1 laggard 


2 poky 


1 talk 


1 association 


1 donkey 


1 lagging 


1 Poughkeepsie 


3 tardy 


1 automobile 


1 drag 


1 lassitude 


1 pupil 


1 team 


1 awful 


1 dragging 


2 late 




1 tedious 




2 dreary 


2 laziness 


1 quality 


1 terrapin 


2 baby 


1 dressing 


23 lazy 


56 quick 


1 thought 


3 backward 


1 drive 


1 lecture 


2 quickly 


1 thoughtful 


1 backwards 


1 driver 


1 leisure 


1 quickness 


1 tide 


1 bad 


1 drone 


1 lingering 


12 quiet 


14 time 


1 bear 


1 Dr. R. 


6 long 




5 tired 


1 beffpar 


7 dull 




1 rain 


2 tiresome 


1 behind 




3 man 


9 rapid 


4 tortoise 


1 better 


2 ease 


1 march 


1 rhythmic 


IS train 


1 Bill 


63 easv 


1 market 


1 river 


1 trains 


3 boat 


1 Erie 


3 me 


1 Rose 


1 trolley 


1 boring 




1 medium 


2 run 


9 turtle 


2 boy 


316 fast 


1 mice 






1 breakdowD 


1 feeble 


1 mind 


1 sharp 


2 unpleasant 




1 fine 


1 mode 


1 short 


1 unsatisfactory 


1 camel 


1 fire 


1 moderate 


1 sick 




1 canal boat 


1 flv 


20 molasses 


1 sickness 


1 vehicle 


6 car 


1 foot 


1 monotonous 


1 slack 




2 cars 


1 funeral 


1 moon 


2 sloth 


7 wagon 


1 careful 




7 motion 


1 slowly 


8 walk 


1 carpenter 


3 gait 


1 motionless 


7 sluggish 


7 walking 


1 cart 


1 gin 


1 move 


10 smart 


1 walks 


1 catch 


1 going 


8 movement 


1 smooth 


1 water 


2 caterpillar 




5 moving 


G2 snail 


1 waves 


1 caution 


2 hard 


1 Mr. T. 


1 snails 


2 weak 


1 child 


3 haste 


3 mule 


1 snake 


1 weather 


1 climb 


2 hasty 


3 music 


1 softly 


1 wheel 


5 clock 


1 heavy 


3 myself 


2 speech 


1 white 


3 coach 


14 horse 




7 speed 


1 work 


1 conversation 


1 hot 


1 nasty 


1 Bpeedless 


1 working 


1 cow 


3 hurry 


1 nature 


1 starting 


1 world 


1 crawl 






2 step 


3 worm 


1 creep 


1 impatience 


1 obstacle 


3 still 


1 writing 


2 creeping 


1 inactive 


2 old 


3 stop 






1 inanition 


2 ox 


1 stubborn 


1 you 


1 dead 


1 incessant 


1 oxen 
26. WISH 


7 stupid 




1 accomplish 


1 candy 


1 doK 


6 fulfilment 


3 heaven 


1 accomplishment 1 cannot 


1 doll 


1 fun 


1 heavens 


1 achieve 


1 check 


1 dollars 




1 help 


1 Aladdin 


2 chicken 


2 dream 


2 gain 


12 home 


2 ambition 


2 child 


1 dress 


14 get 


51 hope 


1 angel 


3 Christmas 


1 driving 


4 gilt 


1 hoping 


1 answer 


1 clover 




1 girl 


2 hopeful 


1 anxiety 


1 clovers 


1 eat 


3 give 


1 house 


1 anxious 


1 cold 


1 entreaty 


1 glad 




1 any 


2 come 


1 enjoyment 


4 go 


2 idea 


7 anj'thinj? 


4 comfort 


1 examination 


1 gold 


1 imagination 


1 apology 


9 command 


1 expectation 


19 good 


1 impossible 


1 ardent 


1 conditions 


5 express 


7 grant 


1 inclination 


8 ask 


2 cool 


1 expression 


15 granted 




1 asking 


1 craving 




4 gratification 


2 journey 


1 attain 




11 fairy 


6 gratified 


1 joy 




2 demand 


2 fancy 


11 gratify 




1 baby 


1 desirable 


1 farm 


1 greetings 


1 know 


2 bcff 


197 desire 


5 favor 


2 guess 




1 benefit 


1 desires 


1 feeling 




2 letter 


1 best 


1 diamond 


1 finish 


18 happiness 


s like 


1 better 


1 disappoint 


t fish 


3 happy 


1 liked 


19 bone 


1 disappointed 


1 fond 


1 hard 


1 lonesome 


1 books 


3 disappointment 


1 foolishness 


2 hat 


10 long 


1 boy 


1 dish 


5 for 


1 hate 


IS longing 


1 boys 


1 dLslike 


•J fortune 


IS have 


2 love 


1 breakfast 


1 did 


1 fulfil 


6 health 


9 luck 


1 brightness 


5 do 


2 fulfilled 


1 hearty 





I9IOJ 



GRACE HELEN KENT AND A. J. ROSANOFF 



6i 



1 make 


1 perhaps 


1 repeat 


9 star 


1 unsatisfied 


1 marry 


1 person 


8 request 


2 stars 




2 million 


1 pick 


1 rest 


1 strong 


2 vacation 


4 mind 


1 picture 


1 rich 


4 success 




32 money 


1 pie 


3 riches 


1 suggest 


6G want 


1 moon 


1 plan 


1 ring 


2 summer 


1 wants 


1 morning 


1 play 




1 sweetheart 


1 wanted 


1 music 


1 pleasant 


1 sail 


1 swim 


9 wanting 


1 myself 


5 pleasure 


1 satisfactory 




1 waste 




2 plenty 


2 satisfied 


18 think 


1 watch 


1 news 


3 position 


1 satisfy 


6 thinking 


1 water 


1 nice 


1 possess 


1 sati3f>-ing 


47 thought 


2 wealth 


1 no 


1 possession 


2 say 


1 toy 


6 well 




2 present 


1 secret 


1 trip 


3 will 


3 obey 


2 promise 


1 sincere 


1 trouble 


2 wisdom 


1 object 




1 sleep 


6 true 


1 wise 


1 obtain 


1 quiet 


1 some 


1 try 


14 wishbone 


1 offer 




15 something 




2 wonder 


1 one 


1 reality 


1 sorrow 


1 unattainable 


2 would 


1 opportunity 


1 receive 


1 sorry 


1 uncertain 


1 wouldn't 


1 opposition 


1 remembrance 


1 speak 


1 unfulfilled 




1 orange 


1 renown 


1 special 


1 unlawful 


1 yes 


1 order 




27. RIVER 




1 you 


1 Amazon 


1 Connecticut 


65 lake 


5 pond 


7 smooth 


1 Androscoggin 


10 creek 


1 lakes 




1 spring 




8 current 


5 land 


1 rain 


1 St. Lawrence 


1 bank 




7 large 


1 Rappahannocli 


117 stream 


2 banks 


1 dangerous 


1 launch 


2 rapid 


1 streams 


1 barrow 


35 deep 


1 length 


1 Rhine 


1 streamlet 


3 bathing 


1 Delaware 


1 life 


1 rill 


1 strong 


1 bay 


1 depth 


1 liquid 


2 ri\-ulet 


1 sunset 


1 beautiful 


1 drowned 


8 long 


1 ri\-ulets 


2 Susquehanna 


1 beauty 






1 row 


3 swift 


1 bend 


4 East 


1 meadow 


1 rowing 


4 swim 


6 blue 




8 Mississippi 


3 run 


4 swimming 


20 boat 


1 fish 


1 Mississquoi 


3 runs 




3 boats 


24 flow 


1 Missouri 


6 running 


1 Tar 


1 boating 


5 flows 


1 Mohawk 


1 rushing 


1 tide 


1 body 


17 flowing 


1 motion 




1 tree 


2 bridge 


1 Freiberg 


10 mountain 


1 Saco 


1 tug 


5 broad 


1 front 


2 moving 


4 sailing 


1 turbulence 


20 brook 






1 salt 




1 bubbling 


1 God 


17 ocean 


14 sea 


5 valley 




1 Grand 


2 Ohio 


2 shallow 




1 Calumet 


1 green 


1 Ottanqueehee 


1 Shannon 


1 Ware 


1 camping 




1 Owasco 


2 shining 


393 water 


1 canal 


33 Hudson 




4 ship 


3 well 


3 canoe 




1 Pacific 


1 ships 


2 wet 


1 canoeing 


1 island 


2 peace 


1 side 


3 white 


1 Chignagnette 




1 Piscatague 


1 sky 


5 wide 


1 cliffs 


1 Jordan 


1 plain 


2 slow 


2 winding 


1 commerce 




1 pleasure 
28. "WHITE 


1 small 


1 winds 


1 almost 


1 cerement 


35 dark 


1 glare 


1 lovely 


2 apron 


1 chair 


1 darkness 


1 good 






3 chalk 


1 day 


2 gray 


2 man 


1 baby 


1 cheerful 


1 daylight 


6 green 


1 marble 


1 beach 


1 cherries 


2 dazzling 




9 milk 


1 beautiful 


10 clean 


1 delicate 


1 hall 


1 Mountain 


1 beauty 


2 cleanliness 


2 dove 


2 handkerchief 


1 Mountains 


1 bird 


1 cleanness 


34 dress 


1 hands 


3 muslin 


308 black 


2 clear 


1 dresses 


1 hard 




1 bleached 


17 cloth 




2 horse 


1 napkin 


9 blue 


1 clothing 


2 easy 


4 house 


1 nearly 


1 boat 


4 cloud 


1 evening 




2 nice 


1 Bob 


2 clouds 




1 innocence 




1 body 


1 coat 


1 face 




5 paint 


1 bride 


170 color 


2 feathers 


1 lady 


2 pale 


4 bright 


1 colored 


2 flag 


1 lawn 


17 paper 


1 brightness 


11 colorless 


2 flower 


3 lead 


1 pencil 


1 Broadway 


3 cotton 




1 lemon 


2 person 


2 brown 


1 cream 


2 garment 


1 He 


1 pigeon 




2 curtain 


1 ghost 


51 light 


2 pink 


2 cat 


1 curtains 




3 linen 


1 pleasing 



52 


A STUDY OF 


ASSOCIATION IN INSANITY 


lJul> 


1 powder 


1 Tightness 


1 silver>- 


1 space 


1 tile 


1 pretty 


2 rose 


1 simple 


1 spread 


1 trees 


20 pure 




1 skirt 


2 still 


1 trousers 


19 purity 


1 sand 


2 sky 


1 summer 






1 Sarah 


91 snow 


1 simlight 


2 waist 


1 race 


1 shade 


1 snowflake 


1 swan 


6 wall 


7 red 


6 sheet 


1 snowy 




1 wash 


1 restful 


1 shoes 


1 soft 


4 tablecloth 


2 wedding 


1 retired 


1 shroud 


1 soul 


1 tent 




1 ribbon 








7 yellow 






30. BEAUTIFUL 




1 admirable 


1 divine 


86 handsome 


1 nicely 


1 sculpture 


1 admiring 


2 dress 


1 happy 


1 night 


1 sensitive 


1 aesthetic 




1 hard 


1 noble 


1 shapely 


1 all 


1 earth 


1 hateful 




1 Bight 


1 ancient 


5 elegant 


2 heaven 


1 object 


16 sky 


2 appearance 


1 enjoyed 


1 heavens 


3 ocean 


1 soft 


6 art 


1 ethereal 


1 hideous 




1 sometimes 


1 artistic 


2 Eunice 


2 hills 


2 Palisades 


1 soothing 


1 article 


1 Evelyn 


27 homely 


1 pansies 


1 sorrowful 


1 attractive 


1 everything 


1 horrible 


1 park 


8 splendid 




4 exquisite 




3 peacock 


1 statue 


1 baby 


1 eye 


1 joy 


1 perception 


1 straw 


1 bird 


2 eyes 




3 perfect 


2 summer 


1 birds 




1 kind 


1 perfection 


1 sun 


1 brilliant 


3 face 




2 person 


8 sunset 


1 building 


5 fair 


5 ladv 


19 picture 


1 sunshine 


2 butterfly 


1 falls 


1 lake 


4 pictures 


1 superb 




2 fancy 


7 landscape 


1 place 


1 supreme 


1 carpet 


1 fascinating 


1 lightness 


2 plain 


4 sweet 


1 carving 


8 fine 


1 long 


14 pleasant 


1 sjTnphony 


7 charming 


13 flower 


1 look 


16 pleasing 




6 child 


42 flowers 


1 looks 


2 pleasure 


2 things 


1 city 


1 foliage 


1 looking 


113 pretty 


4 tree 


1 classic 


1 forest 


2 lovable 




10 trees 


1 clear 


1 Formosa 


64 lovely 


1 queen 




1 clouds 


1 fragrant 


1 luxurious 




2 ugliness 


1 color 


2 friend 




1 rainbow 


66 ugly 


1 colors 




10 magnificent 


1 religion 




3 comely 


Igift 


2 maiden 


1 resplendent 


1 vanity 


1 common 


24 girl 


2 man 


1 ribbon 


1 verdure 


3 complexion 


2 glorious 


1 mansion 


1 rich 


1 violets 


1 conceited 


2 God 


1 money 


1 robin 




3 country 


4 good 


1 morning 


6 rose 


4 weather 


1 curtain 


2 gorgeous 


2 mountain 


2 roses 


1 wife 




1 graceful 


6 mountains 




29 woman 


1 dainty 


40 grand 


4 music 


1 sad 


1 women 


7 day 


2 grandeur 


1 myself 


1 satisfaction 


1 wonderful 


1 delicious 


1 grass 




1 scarce 


2 world 


5 delightful 


1 grounds 


16 nature 


1 scene 




1 description 




1 Niagara Falls 


23 scenery 


1 you 


1 desire 


Ihand 


73 nice 
30. WINDOW 


1 school 




12 air 


1 danger 


2 lattice 


20 sash 


2 sunshine 


1 airing 


2 dirty 


1 ledge 


2 scene 




1 airy 


57 door 


186 light 


3 scenery 


1 thing 


2 aperture 


1 doors 


15 look 


2 school 


1 translucent 


1 awning 


1 doorway 


5 looking 


1 screen 


1 transom 




1 draught 


1 low 


1 screens 


24 transparent 


1 bars 






1 seat 


2 trees 


4 blind 


1 eyes 


1 Newcastle 


9 see 




1 breeze 






8 shade 


2 useful 


3 bright 


1 few 


1 object 


2 shades 




2 broken 


5 frame 


ir» open 


1 shed 


1 vast 






1 opened 


1 shining 


5 ventilation 


1 cage 


1 garden 


16 opening 


7 sight 


2 ventilator 


3 casing 


316 glass 


1 outdoors 


1 sightly 


15 view 


1 children 


1 glasses 


E outlook 


13 sill 


1 viewing 


1 church 






1 sky 


1 visible 


6 clean 


4 hole 


82 pane 


3 sKvIight 


1 vision 


1 cleaner 


1 home 


6 panes 


1 small 




7 clear 


22 house 


1 picture 


1 square 


4 wall 


1 colored 




1 porch 


2 stained 


1 wash 


1 cool 


1 joyful 




1 stop 


2 wide 


13 curtain 




1 rain 


1 street 


2 winter 


4 curtaina 


2 landscape 


1 rock 


1 structure 


1 wood 




11 large 


3 room 


3 sun 





[910] GRACE HELEN 


KENT AND A. 


J. ROSANOFF 


63 






31. ROUGH 






4 bad 


2 earth 


1 knife 


5 ragged 


3 street 


1 bag 


2 easy 




1 railway 


6 surface 


1 ball 


2 even 


1 lake 


1 rasp 




1 basket 




1 land 


5 ready 


4 table 


1 bear 


1 (ace 


3 level 


1 refined 


1 tempeetuou3 


1 blistere 


1 fast 


1 luck 


1 rider 


1 tongue 


Iblow 


7 file 


1 lump 


1 riders 


2 touch 


10 board 


2 fine 




1 river 


2 touffh 


1 boards 


6 floor 


8 man 


21 road 


1 towel 


4 boisterous 


2 football 


1 manner 


5 roads 


4 tramp 


2 bold 


1 forest 


1 manners 


10 rock 


1 trouble 


4 boy 




1 material 


10 rocks 


1 tumble 


4 boys 


1 gambler 


1 me 


12 rocky 


1 turbulent 


1 bristle 


1 genteel 


1 mean 


1 rowdy 




2 brush 


8 gentle 


3 mild 


1 ruddy 


4 ugly 


3 brutal 


1 girl 


6 mountain 


7 rude 


4 uncomfortable 


1 brutality 


1 granite 


1 mountains 


1 rudeness 


4 uncouth 


1 bumpy 


1 granular 




1 rug 


1 uneasy 




1 grater 


1 nice 


22 rugged 


38 uneven 


2 calm 


1 grating 


1 noisy 


1 ruggedneas 


1 unfairness 


1 careless 


1 gravel 




1 Russian 


1 unfinished 


2 carpet 


8 ground 


1 obstetricians 


1 rut 


7 unpleasant 


1 chaps 




27 ocean 




1 unsatisfactory 


4 cloth 


1 hairy 


1 orange 


5 sand 


1 untaught 


29 coarse 


IhaU 




13 sandpaper 




1 coarseness 


2 hand 


1 paper 


1 savage 


1 voices 


1 cobblestones 


38 hard 


1 pavement 


15 sea 


2 voyage 


1 cold 


1 hardness 


1 peasant 


1 sedate 


5 vulgar 


2 country 


10 harsh 


1 pebbles 


1 scratch 




2 crooked 


1 harshness 


2 person 


1 shock 


2 walk 


1 cross 


1 haste 


1 picture 


1 sliver 


1 wall 


1 cruel 


2 hill 


1 pineapple 


1 slow 


1 washing 




2 hills 


2 plane 


846 smooth 


21 water 


1 desert 


5 hilly 


1 plank 


3 smoothness 


5 waves 


1 difficult 


1 horrid 


1 play 


4 soft 


1 weary 


1 dirt 


1 hovise 


1 poor 


1 sponge 


4 weather 


3 disagreeable 




1 porcupine 


1 stem 


1 west 


I discomfort 


3 ice 


1 push 


1 sticky 


2 wild 


1 discouraging 


1 impertinent 




12 stone 


2 wind 


1 dog 


1 injurious 


1 quality 


8 stones 


1 winds 


1 dress 


2 iron 


1 quiet 


7 stony 


7 wood 


3 dri' 


2 irregular 


1 quite 


5 storm 


1 woodsman 


1 dull 






1 stormy 


1 work 




1 jagged 


1 radiator 
32. CITIZEN 


1 straight 


1 world 
1 WTong 


14 alien 


1 commander 


1 fine 


1 inhabit 


2 men 


5 America 


3 community 


2 five 


23 inhabitant 


1 merry 


35 American 


1 comrade 


1 tool 


1 invader 


1 moral 


3 Americans 


1 conspirators 


1 foreign 


1 Italian 


1 Mr. A. 


1 army 


1 constitution 


19 foreigner 




1 Mr. C. 


1 arrived 


1 cosmopolitan 


1 tree 


2 justice 


1 Mr. S. 




1 countrified 


2 freeman 




1 municipal 


4 belong 


17 country 


1 friend 


1 K. 


1 myself 


1 belonging 


7 countryman 


1 friendship 


1 king 




1 beloved 


1 criticise 






1 name 


1 beneficial 




1 gardener 


1 large 


1 nationality 


1 bird 


1 democrat 


8 gentleman 


11 law 


25 native 


3 bom 


2 duties 


3 German 


1 laws 


1 natural 


1 Brooklj-n 


3 duty 


26 good 


3 lawyer 


1 naturalization 


1 brother 


1 dweller 


6 government 


1 leader 


5 naturalized 


1 business 


1 dwelling 


1 green 


1 leading 
1 legislature 


1 navy 
1 near 


1 C. 


1 ear 


1 helper 


1 Lincoln 


3 neighbor 


1 candidate 


1 election 


3 home 


1 little 


1 newspaper 


1 capital 


1 eligible 


2 honest 


1 live 


4 New York 


1 cat 


2 emigrant 


1 honor 


1 lives 


1 noble 


1 cistern 


1 emigration 


2 honorable 


3 loyal 


2 nobleman 


1 citizeness 




3 human 




I nonsense 


27 city 


1 F. 




7 male 




4 civics 


1 faithful 


1 I 


278 man 


1 obedient 


2 civilian 


1 farm 


1 immigrant 


1 manhood 


1 obey 


4 civilized 


3 farmer 


1 independence 


6 mayor 


1 occupant 


1 clothes 


3 fellow 


1 Indian 


1 me 


2 office 


Iclub 


2 fellowship 


4 individual 


5 member 


1 officer 



64 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



1 old 


4 politician 


1 righteousness 


1 suburban 


1 xmit 


1 orderly 


1 politicians 


2 Roman 


3 suffrage 


V) United States 


1 outlaw 


8 politics 
1 poor 


2 Roosevelt 
1 ruler 


2 suffragette 


2 useful 


2 paper 


4 president 




3 Taft 


2 village 


2 papers 


1 proud 


1 season 


I Tammany 


13 vote 


1 patrician 




1 ship 


1 taxes 


4 voting 


2 patriot 


1 relative 


5 soldier 


1 Teddv 


35 voter 


2 patriotic 


3 republic 


in state 


1 thoughtful 




1 peasant 


1 republican 


5 statesman 


1 tough 


1 Washington 


41 people 


2 residence 


1 stationed 


5 town 


2 woman 


64 person 


20 resident 


1 straight 


5 townsman 


2 work 


1 plebeian 


1 respectable 


5 subject 






2 policeman 


1 revolution 


33. FOOT 


2 undesirable 


1 years 


2 anatomy 


1 finger 


1 labor 


1 pedant 


1 standard 


2 animal 


1 firm 


1 lame 


1 pedestal 


6 step 


11 ankle 


1 flat 


14 large 


1 pedestrian 


1 stepping 


2 appendage 


6 flesh 


54 leg 


5 person 


2 stocking 


11 arm 


1 football 


1 legs 


1 plaster 


1 stone 




3 foundation 


2 length 




1 strength 


1 baby's 




5S limb 


2 quadruped 


1 strong 


1 base 


1 gear 


2 long 




1 stumps 


1 bicvcle 


1 girls 




1 rheumatism 


1 support 


2 big 


1 going 


5 man 


1 right 


1 swiftness 


3 black 


1 good 


3 measure 


1 rubber 




34 body 


2 ground 


10 member 


4 rule 


1 three 


4 bone 




1 mine 


1 ruler 


5 tired 


5 bones 


1S5 hand 


1 Miss F. 


2 run 


3n toe 


6 boot 


5 hands 


2 movement 




41 toes 


1 bottom 


7 head 


1 music 


1 shape 


2 travel 


1 broken 


3 heel 




146 shoe 


1 trod 


1 brown 


1 help 


1 nail 


17 shoes 


1 twelve 




1 helper 


1 naked 


4 short 


1 two 


1 careful 


1 horse 


2 necessity 


1 size 




3 comfort 


1 house 


1 needful 


1 skin 


5 useful 


3 corn 


1 human 




2 slipper 




2 corns 


1 humility 
1 hurt 


1 organ 


22 small 
1 sole 


1 velocity 


1 daintv 




1 pain 


S sore 


106 walk 


1 difficult 


3 inch 


1 painful 


1 speed 


38 walking 


1 distance 


2 inches 


2 part 

1 pavement 


1 stability 
6 stand 


1 warm 


1 expansive 


4 kick 


3 pedal 


1 standing 


1 yard 


9 extremity 


2 knee 


34. SPIDKR 






1 abhorrence 


1 crawls 


4 flies 


3 nasty 


1 stung 


1 afraid 


11 crawling 


136 fly 


1 nest 


1 study 


38 animal 


1 crawly 


1 fright 


2 net 




1 annoyance 


2 creature 


1 fry 


1 nuisance 


3 tarantula 


3 ant 


6 creep 


1 frying 




1 thing 


2 arachnida 


1 creeps 




1 objectionable 


2 thread 


1 arachnoid 


7 creeping 


1 grass 


1 obnoxious 


1 tortoise 


1 awful 


1 creepiness 




1 octopus 


1 treachery 




5 creepy 


1 harlequin 




1 tree 


3 bee 


2 cricket 


1 harmful 


1 pain 




2 bees 


1 cringe 


1 horrible 


1 pan 


6 ugly 


4 beetle 


1 cross 


4 horrid 


1 pest 


1 undesirable 


1 big 


1 crow 


3 horror 


m poison 


1 unpleasant 


2 bird 


1 cunning 




1 poisonous 




2f) bite 




1 industry 


1 pretty 


2 venomous 


8 black 


1 daddy-long- 


, 276 insect 




1 vermin 


1 breakfast 


legs 




1 rats 




58 bug 


1 danger 


1 jumping 


2 Robert Bruce 


1 walk 


2 bugs 


4 dangerous 




1 roach 


1 wall 


5 butterfly 


2 dark 


5 large 


1 room 


6 wasp 




1 dirty 


3 leg 




1 watching 


1 camp 


3 disagreeable 


27 legs 


1 shivt-rs 


2 weaves 


3 caterpillar 


1 displeasure 


1 loathsome 


1 shudder 


1 weaving 


1 centipede 


1 dread 


1 long 


1 sinister 


ISS web 


1 chills 






2 small 


3 webs 


1 climb 


1 evil 


1 Miss Muffet 


1 snake 


1 wiggly 


12 cobweb 




1 mosquito 


1 snakes 


4 worm 


2 cobwebs 


3 fear 


1 moth 


1 sparrow 




1 country 


1 fish 


1 movements 


7 sting 


1 young 


14 crawl 






1 stings 





igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



65 







35. NBEDLE 






3 article 


2 dressmaker 


4 knitting 


1 pincushion 
40 point 


1 stitching 
1 surgeon 


1 blood 


1 embroidery 


1 labor 


9 pointed 




2 book 


17 eye 


1 long 


10 prick 


1 tailor 


1 broken 






1 pricks 


2 thick 


1 button 


3 fine 


1 magnetic 


2 pricking 


15 thimble 


1 buttons 




1 material 




2 thin 




1 handy 


1 mending 


134 sew 


160 thread 


1 camel 


1 help 


3 metal 


1 sews 


5 tool 


4 cloth 


1 hole 




107 sewing 




2 clothes 


1 home 


1 nail 


152 sharp 


1 use 


2 coat 


1 housewife 




4 sharpness 


1 using 


7 cotton 


2 hurt 


1 ornament 


1 shiny 


12 useful 


1 crocheting 


2 hypodermic 




1 slippers 




1 cut 




1 patching 


2 small 


1 weapon 




5 implement 


147 pin 


53 steel 


1 wire 


4 darniner 


2 industry 


11 pins 


2 sting 


1 woman 


1 diligence 


26 instrument 


36. RED 




6 work 


1 aggravating 


1 cheeks 


1 fright 


1 jacket 


2 rug 


1 anarchist 


1 cheer 


2 flower 






2 anger 


1 cherries 


1 flowers 


1 lavender 


3 scarlet 


13 apple 


1 closet 


1 flushing 


1 light 


1 shoe 


3 apples 


8 cloth 




Hips 


2 sky 




1 clouds 


1 garment 




1 smooth 


1 ball 


2 coat 


3 garnet 


1 maroon 


1 soldier 


1 banner 


254 color 


1 gaudy 


1 Mars 


1 spots 


2 barn 


1 colors 


2 glaring 


1 mixture 


1 story 


2 beauty 


1 colored 


1 glass 


1 moon 


5 sun 


1 becoming 


1 coloring 


1 globe 




3 sunset 


61 black 


1 comfortable 


1 glow 


1 object 


1 sweater 


71 blood 


1 Cornell 


1 grass 


1 objectionable 




1 bloody 


1 cow 


30 green 


1 offensive 


1 tablecloth 


1 blossom 


2 crimson 




1 orange 


4 thread 


99 blue 


2 curtain 


6 hair 




1 tie 


8 book 




1 handsome 


5 paint 


1 tomatoes 


1 bravery 


14 danger 


1 hat 


4 paper 


2 turkey 


3 brick 


6 dark 


2 head 


1 passion 




2 bricks 


1 dashy 


1 healthy 


1 pencil 


1 vi\*id 


4*1 bright 


1 dislike 


4 heat 


1 pink 




2 brightness 


18 dress 


1 Hereford 


1 plush 


1 war 


3 brilliant 




1 holly 


1 poinsettia 


6 warm 


1 brook 


1 eat 


1 hood 


2 pretty 


3 warmth 


7 brown 


1 Ed 


1 horse 


6 purple 


1 whiskey 


1 building 




Shot 




97 white 


2 bull 


2 fiery 


2 house 


2 ribbon 


1 wool 




31 fire 




1 riding 


1 world 


1 cap 


16 flag 


2 Indian 


2 robin 




1 cape 


3 flannel 


4 ink 


15 rose 


1 yam 


1 carpet 


1 flashy 


1 iron 


2 rosy 


15 yellow 


1 ceiling 




37. SLEEP 






94 awake 


2 dead 


4 eat 


1 habit 


1 midnight 


1 awaking 


7 death 


1 enjoyable 


1 happiness 


1 myself 


3 awaken 


5 deep 


1 enjo.\-ment 


3 health 




1 awakening 


1 desire 


1 enough 


1 heavy 


1 natural 




1 desperate 


1 experiment 


1 home 


4 necessary 


2 baby 


1 dope 


10 eyes 




1 need 


1 beautiful 


2 dormitory 




2 insomnia 


1 needful 


75 bed 


1 dose 


1 fast 




1 nice 


1 bedstead 


4 doze 


2 fatigue 


1 lady 


49 night 




28 dream 


1 fine 


1 leisure 




2 calm 


10 dreams 


2 forgetfulness 


1 lain 


1 peace 


1 chance 


6 drowsy 




3 lie 


1 peaceful 


2 child 


3 drowsiness 


1 gentle 


1 lying 


2 peacefulness 


1 children 


1 dullness 


1 girl 


1 luxurious 


1 perfect 


1 coma 




1 go 


1 luxury 


5 pillow 


30 comfort 


3 ease 


5 good 




3 pleasant 




4 easy 




1 mesmerism 


1 plenty 



66 



A STUDY OF ASSOCIATION IN INSANITY 



[J"iy 



1 poorly 


2 refreshment 


1 senses 


1 song 


60 wake 


1 potassium bro- 


1 relax 


1 Shakespeare 


2 soothing 


4 wakefulness 


mide 


31 repose 


1 sheet 


16 sound 


1 wakened 


2 profound 


300 rest 


1 shut 


3 soundly 


1 wakening 




14 resting 


1 silence 


2 still 


4 waking 


8 quiet 


9 restful 


1 sleeplessness 


3 sweet 


2 walk 


2 quietness 


4 restless 


1 sleepy 




1 wanting 


1 qiiietude 


1 restore 


20 slumber 


1 thinking 


1 watchful 




2 restorer 


2 slumbering 


26 tired 


3 weariness 


1 rage 


1 retiring 


4 snore 


1 tiresome 


1 weary 


2 recline 


1 rise 


1 soft 




1 well 


1 reclining: 


1 rising 


1 solace 


12 unconscious 


1 woman 


7 refreshing 






7 uncotnsciousness 






38. ANGER 






1 abuse 


5 disturbed 


1 horror 


1 nonsense 


1 slow 


1 aggravated 


4 dog 


3 hot 


1 not 


2 smooth 


2 aggravation 


1 downhearted 


1 hot-headed 


1 noticeable 


1 sober 


1 agony 


1 duel 


1 house 




1 soft 


2 amiability 




1 humor 


1 obey 


1 soldier 


1 amiable 


3 emotion 


1 hunger 


1 out 


1 sometimes 


6 angry 


2 enemy 


1 hysteria 


1 outrage 


1 soothing 


2 anguish 


1 energy 






10 sorrow 


1 annoyance 


1 enmity 


1 ill 


1 pain 


1 spite 


3 annoyed 


1 excitability 


4 impatience 


51 passion 


1 spiteful 


1 appearance 


3 excited 


8 impatient 


1 passionate 


1 storm 


1 aroused 


4 excitement 


1 Indian 


3 patience 


1 strike 


1 awful 


1 exclamation 


1 indignant 


6 peace 


1 strong 






2 indignation 


1 peaceful 


1 suffering 


13 bad 


1 face 


1 insanity 


1 peevish 


1 sulky 


2 bitter 


1 father 


1 insult 


2 person 


1 swear 


3 bitterness 


9 fear 


1 insulted 


1 placid 


1 sweetness 


1 blow 


4 feeling 


1 intense 


5 pleasant 


1 sword 


1 blows 


1 ferocity 


1 intensity 


4 pleasure 




1 blush 


1 fierce 


1 intoxication 


2 provocation 


1 talking 


3 boy 


1 fierv 


2 ire 


1 provoke 


2 teacher 


1 breathing 


8 fight 


1 irritable 


1 provoked 


1 tears 




1 fighting 




2 provoking 


140 temper 


7 calm 


1 fist 


1 jealousy 




1 temperament 


1 calmness 


1 flush 


1 Jimmy 


3 quarrel 


1 terrible 


2 cat 


1 foolish 


4 joy 


2 quarreling 


1 terror 


1 catching 


3 foolishness 


1 joyful 


1 quarrelsome 


3 thought 


2 cause 


1 force 


1 judgment 


4 quick 


1 torment 


1 character 


1 forgive 




1 quickness 


6 trouble 


1 cheer 


3 forgiveness 


2 kind 


6 quiet 


1 turbulent 


1 child 


1 frenzy 


2 kindness 


1 quietness 


1 turmoil 


1 children 


1 fret 




1 quite 




1 choler 


1 fright 


1 laughter 




1 ugliness 


1 cold 


1 frown 


1 light 


16 rage 


4 ugly 


3 command 


1 frowning 


2 lion 


1 rarely 


1 unbecoming 


1 compose 


1 fun 


1 little 


1 rashly 


1 uncomfortable 


5 control 


2 furious 


3 loud 


1 rashness 


1 unhealthy 


1 cool 


4 fury 


5 love 


1 raving 


4 impleasant 


1 crankj- 




1 low 


1 reason 




1 crazy 


2 gentle 




3 red 


1 very 


44 cross 


3 gentleness 


121 mad 


1 remorse 


3 vexation 


2 crossness 


1 giant 


1 maddest 


2 resentment 


13 vexed 


1 covetous 


1 girl 


19 madness 


1 resistive 


1 \ncious 


1 cruel 


4 glad 


2 malice 


1 rest 


1 violence 


1 cry 


2 gladness 


(i man 


1 restless 


2 violent 




2 good 


1 mean 


8 revenge 


1 voice 


1 danger 


1 great 


4 meekness 


2 riled 




1 deliberation 


3 grief 


1 mild 


3 rough 


1 war 


1 despise 


1 grieve 


4 mind 


1 roughness 


5 wicked 


1 devil 


2 grouchy 


2 mirth 


1 rude 


1 wickedness 


4 disagreeable 




2 myself 




1 wish 


1 disappointed 


4 happiness 




1 sad 




2 disappointment 


2 happy 


1 name 


2 scold 


4 woman 


3 discomfort 


3 harsh 


1 nature 


2 scolding 


1 words 


1 dishonor 


2 haste 


1 nerves 


1 scowl 


62 wrath 


1 dislike 


3 hasty 


1 nervous 


1 sedative 


1 wrathful 


1 disobedience 


9 hate 


1 never 


1 selfishness 


2 wroth 


1 disobedient 


1 hateful 


1 nice 


1 sharp 


4 wrong 


2 displeased 


26 hatred 


2 noise 


1 shorn 




2 displeasure 


1 headache 


1 noisy 


1 sick 


1 yelling 


3 disturbance 


1 horrid 


1 none 


1 sin 





I 



I9I0] 



GRACE HELEN KENT AND A. J. ROSANOFF 



67 



39. CARPET 



1 appearance 


1 curtains 


8 green 


1 pattern 


10 sweeper 


1 article 






1 pennant 






1 dark 


1 hall 


1 pleasant 


1 table 


1 beat 


6 design 


3 heavy 


2 plush 


8 tack 


2 beating 


1 designer 


4 home 


4 pretty 


3 tacks 


1 beater 


2 dirt 


4 house 


2 protection 


2 tapestry 


2 beautiful 


1 down 






2 textile 


1 beautifying 


1 drag 


2 ingrain 


1 quick 


2 thread 


2 beauty 


1 dullness 






2 tread 


1 bedroom 


4 dust 


Hay 


7 rag 




2 blue 


1 duster 


1 loom 


3 rags 


2 use 


2 bright 




1 lot 


1 ragged 


1 useful 


1 broom 


3 ease 


3 luxury 


8 red 




2 brown 


1 electric 




1 reddish 


9 velvet 


1 brush 


1 expense 


6 mat 


1 refinement 




1 brushes 




3 material 


1 rich 


15 walk 


11 Brussels 


2 fancy 


10 matting 


17 room 


6 walking 




3 figure 


1 mattress 


2 rough 


1 wall 


1 chair 


1 flat 


1 microbes 


163 rug 


1 Wanamakcr 


1 chairs 


256 floor 


1 moss 


14 rugs 


2 warm 


S clean 


2 flooring 






5 warmth 


2 cleaning 


2 foot 


1 nail 


1 shoes 


1 weaver 


1 cleaner 


1 fur 


1 neatness 


1 small 


1 weaving 


20 cloth 


1 furnishing 


2 nice 


8 smooth 


1 wear 


6 color 


4 furniture 


1 none 


78 soft 


1 white 


1 colors 






4 softness 


1 wide 


15 comfort 


1 germs 


7 oilcloth 


2 stairs 


1 wood 


3 comfortable 


2 good 


1 oriental 


1 stove 


10 wool 


2 cotton 


4 goods 


2 ornament 


1 straw 


7 woolen 


27 cover 


1 grain 




7 sweep 


1 worsted 


76 covering 


Igray 


3 parlor 


3 sweeping 


2 woven 






40. GIRIi 




1 ankles 


2 cute 


3 hair 


7 maid 


6 sister 


1 Annie 




1 hand 


13 maiden 


2 sixteen 


1 associate 


2 dainty 


5 handsome 


1 maidenhood 


1 skirts 




1 damsel 


1 happiness 


1 male 


1 slender 


1 baby 


1 dance 


1 harmlessness 


7 man 


1 slight 


1 Beatrice 


1 dancing 


1 has 


1 men 


1 slim 


8 beautiful 


2 daughter 


3 hat 


1 meek 


8 small 


6 beauty 


1 delight 


1 head 


1 mischievous 


1 smart 


9 being 


1 diabolo 


1 here 


4 miss 


1 smartness 


1 belt 


1 domestic 


1 hood 


1 Miss S. 


1 student 


Ibig 


1 Doris 


1 hoop 


1 modesty 


1 studious 


1 biped 


1 Dorothy 


7 human 


2 mother 


3 study 


1 blonde 


1 dream " 


1 humanity 


2 myself 


1 stylish 


1 blooming 


8 dress 






1 summer 


1 book 


4 dresses 


1 immature 


2 neat 


4 sweet 


S50 boy 




2 infant 


2 necessity 


1 sweetnesft 


3 bo™ 


1 Effle 


3 innocence 


11 nice 


2 sweetheart 


2 braids 


1 Ethel 


1 innocent 


2 niece 




1 bright 


1 eyes 


1 intelligent 
1 Irene 


1 noise 


1 talks 
4 tall 


1 changeable 


1 fair 




1 Pelar 


1 thoughtless 


1 cheerful 


2 fellow 


I jealousy 


18 person 




49 child 


77 female 


2 jolly 


1 petticoats 


1 ugly 


2 children 


3 feminine 


2 joy 


2 play 


1 useful 


2 childhood 


3 flesh 




4 pleasure 




1 childish 


1 flirtation 


1 kid 


29 pretty 


1 vanity 


1 choice 


1 Frances 




1 pupil 


2 virgin 


1 class 


7 friend 


20 ladv 






1 classmate 


1 futurity 


1 large 


1 quick 


1 walk 


1 clever 




1 lassie 


1 rarely 


1 water 


4 clothes 


1 garden 


1 learning 


1 running 


2 weak 


1 clothing 


1 gay 


3 little 




1 white 


1 Coleen 


1 gentility 


1 lively 


1 saucy 


1 wife 


1 college 


1 gentle 


1 Lizzie 


19 school 


61 woman 


2 companion 


1 Gertrude 


3 love 


3 servant 




1 cook 


6 good 


1 loving 


4 sex 


31 young 


1 cunning 


1 grace 


4 lovely 


1 shirk 


1 youngster 


2 curls 






4 silly 


24 youth 



68 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







41. HIGH 






9 above 


2 dizzy 


24 house 


16 mountains 


1 staff 


5 air 




1 houses 


1 myself 


1 stand 


1 Alps 


11 elevated 






13 steep 


14 altitude 


2 elevation 


1 ideal 


1 notion 


12 steeple 


1 ascend 


1 erect 


1 ideas 




1 stick 




2 exalted 


1 immense 


4 peak 


1 stone 


1 bank 


1 extended 




1 pine 


1 summit 


1 beam 




2 jump 


1 pinnacle 


2 swing 


1 beanstalk 


3 fall 




1 play 




3biB 


2 falling 


1 kite 


8 pole 


57 tall 


1 bridge 


1 far 


2 ladder 


1 power 


1 temperature 


24 building 


1 fast 


5 large 


3 precipice 


1 temple 


2 buildings 


2 fear 


7 length 




5 top 




1 feet 


1 lighthouse 


2 reach 


12 tower 


1 Cathedral 


3 fence 


20 lofty 


1 rich 


19 tree 


4 ceiling 


1 first 


7 long 


1 rocky 


4 trees 


2 chair 




328 low 


3 roof 




2 church 


2 giant 




1 room 


26 up 


1 cliff 


1 great 


1 magnificent 




1 upward 


1 climb 




1 man 


1 sre 




1 climbing 


1 hat 


2 mast 


1 shallow 


1 valley 


7 clouds 


1 heaven 


1 measure 


3 short 


1 vision 




3 heavens 


3 medium 


1 skies 




5 deep 


1 heavenward 


1 Metropolitan 


17 sky 


6 wall 


4 depth 


14 height 


1 mind 


2 skyscraper 


1 waves 


1 dimension 


20 hill 


2 monument 


1 small 


2 wind 


11 distance 


4 hills 


1 mount 


1 soft 


1 woman 


3 distant 


1 hot 


157 mountain 


1 spire 





42. WORKING 



1 accomplish 


2 earning 


2 horse 


1 


making 


1 prosperous 


1 accomplishment 


2 ease 


1 hour 


50 


man 




3 active 


1 easiness 


1 house 


6 


men 


1 quick 


1 activity 


4 easy 




1 model 




1 always 


2 eating 


44 idle 


4 


money 


1 railroad 


1 ambition 


1 effort 


in idleness 


1 


morning 


1 reading 


5 ambitious 


10 employed 


2 idling 


3 


motion 


1 recreation 


1 anxious 


1 employers 


1 inconvenience 


2 


movement 


17 rest 


1 apron 


4 employment 


1 indolent 


5 


mo\'ing 


24 resting 


1 attendant 


2 energetic 


13 industrious 


1 


mowing 


1 result 




3 energy 


8 industry 


2 


myself 


1 rowing 


1 bent 


2 engaged 


1 intelligent 






3 running 


1 book 


1 English 


1 interest 


4 


necessary 




2 boy 


1 essay 


2 Italian 


1 necessity 


1 salary 


2 broom 


15 exercise 


1 job 


1 


neighbor 


1 satisfaction 


6 business 


1 exercising 




1 


never 


1 saving 


51 busy 


3 exertion 


1 keeping 


1 


night 


6 school 








1 noble 


3 scrubbing 


1 carpenter 


3 factorv 


147 labor 


1 


nothing 


2 servant 


3 class 


2 fair 


20 laboring 


1 


nursing 


1 setting 


1 comfort 


1 faithfully 


1 labors 






7 se\ving 


1 complication 


1 farm 


• 5 laborer 


1 


obstetrics 


2 shirking 


2 content 


1 fast 


1 lack 


13 


occupation 


7 shop 


2 continually 


3 father 


1 ladies 


1 


occupied 


1 shorthand 


1 continuous 


7 fatigue 


1 late 


1 


occupy 


1 sickness 


1 cooking 


2 fatigued 


2 laziness 


2 


order 


1 singing 




1 eeld 


18 lazy 






3 sitting 


6 (lay 


1 flowers 


1 leisure 


1 


paid 


4 slave 


1 difficult 


1 foundry 


1 Lillie 


1 


patients 


1 slavery 


1 dipping 


1 function 


1 little 


5 


people 


1 slaving 


1 diligence 




1 live 


2 


person 


2 sleep 


1 discomfort 


2 girl 


2 livelihood 


1 


perspiration 


8 sleeping 


2 do 


4 good 


living 


S 


id ay 


1 slow 


10 doing 




1 loaf 


22 


plaj-ing 


1 smart 


1 done 


2 hammer 


5 loafing 


1 


pleasant 


1 starving 


1 drawing 


3 hands 


1 loafer 


4 


pleasure 


2 steady 


1 driving 


1 happiness 


1 lounging 


1 plow 


1 stenographer 


1 drudge 


105 hard 




1 ■ 


plowing 


2 strenuous 


1 dusting 


2 health 


2 machine 


1 


policy 


1 stniggle 


1 duties 


1 healthy 


1 machinery 


1 


position 


5 study 


2 duty 


1 hoeing 


1 machinist 


1 


possession 


5 studying 



I9IOJ 


GRACE HELEN 


KENT AND A. 


J. ROSANOFF 


69 


1 sweep 


1 thought 


9 toiling 


2 unemployed 


1 weariness 


3 sweeping 


1 time 


2 tools 


2 useful 


2 willins 


1 swift 


28 tired 


1 treadmill 




2 woman 




3 tiresome 


1 trouble 


4 wages 


1 work 


1 table 


1 tiring 


2 trying 


2 walking 


1 workman 


2 task 


1 to-day 


1 tj-pewTiter 


1 washerwoman 


1 world 


1 thinking 


7 toil 


43. SOUR 


5 washing 


2 writing 


1 acetic 


1 delight 


1 juice 


15 pickle 


1 stomach 


23 acid 


18 disagreeable 




26 pickles 


2 sugar 


1 acrid 


1 dislike 


2 kraut 


1 pleasant 


349 sweet 


1 anger 


3 disposition 




1 plum 




1 angry 


4 distasteful 


78 lemon 


1 plums 


17 tart 


27 apple 


1 drink 


17 lemons 


3 pucker 


55 taste 


10 apples 




1 lime 




2 tasting 


1 astringent 


1 face 




3 quince 


2 tasteless 




1 flavor 


1 man 




1 teeth 


6 bad 


3 fruit 


31 milk 


1 rancid 


1 turned 


1 beer 






1 repulsive 


1 twinge 


70 bitter 


1 gall 


3 nasty 


5 rhubarb 




1 bitterness 


4 good 


1 naturally 


1 rough 


4 ugly 




1 goodness 


3 nice 




1 unhappy 


3 cherries 


3 grape 


1 no 


2 salt 


3 unpalatable 


2 cider 


36 grapes 


1 nourishing 


1 salty 


16 unpleasant 


1 cross 


2 grapefruit 




2 sauerkraut 


1 unpleasantness 


1 crowd 


1 green 


1 odor 


1 sear 


1 unsweetened » 


1 currants 




2 orange 


2 sharp 






1 hate 




1 soft 


91 ^nnegar 


1 dangerous 


1 hurts 


1 painful 


1 song 




1 death 




1 persimmon 


1 spoiled 


1 wholesome 
1 wine 







44. EARTH 






1 agriculture 


115 dirt 


1 growth 


2 mould 


5 sand 


3 air 


4 dirty 




1 mouldy 


31 sky 


1 ashes 


1 dogs 


2 habitation 


4 mountain 


1 smelly 




4 dry 


4 hard 


2 mountains 


3 smooth 


i ball 


9 dust 


31 heaven 


16 mud 


2 sod 


3 beautiful 




1 heavens 




5 soft 


2 big 


3 farm 


2 heavy 


4 nature 


37 soil 


7 black 


1 farming 


1 hell 




1 solid 


1 body 


1 fence 


1 hemisphere 


1 object 


2 solidity 


2 broken 


1 fertile 


3 home 


1 ocean 


1 space 


17 brown 


1 fertilized 


1 house 


1 one 


4 sphere 


1 building 


4 field 
1 fields 


1 huge 


1 orange 


1 star 

2 stone 


1 cemetery 


1 flag 


1 inhabitable 


1 paradise 


2 stones 


71 clay 


3 floor 




1 place 


1 street 


1 climate 


1 flower 


28 land 


17 planet 


1 substance 


1 cloud 


8 flowers 


7 large 


2 plant 


4 sun 


1 coffin 


1 foot 


1 level 


5 plants 


3 surface 


2 cold 


1 foundation 


3 live 


1 planting 




1 color 


1 fresh 


2 living 


1 pleasure 


1 travel 


2 Columbus 


1 fruitful 


3 loam 


1 potential 


4 tree 


1 continent 


1 Fuller's 


1 lot 


1 productive 


5 trees 


2 corn 




2 low 


1 put 




2 country 


8 garden 






1 unfertile 


1 cover 


1 geranium 


1 man 


1 rain 


8 universe 


1 creation 


16 globe 


2 map 


1 rampart 




1 crunching 


2 grain 


3 Mars 


1 rest 


1 vastness 


1 crushed 


1 grand 


1 mass 


1 revolution 


1 vegetable 


5 crust 


11 grass 


1 material 


4 rich 






3 grave 


1 matter 


1 river 


3 walk 


5 damp 


2 gravel 


1 metal 


1 road 


10 water 


10 dark 


1 gravity 


1 mine 


2 rock 


1 wide 


1 delve 


2 great 


1 mineral 


2 rocks 


1 wood 


2 depth 


3 green 


3 moist 


61 round 


46 world 


Idig 


1 greenhouse 


11 moon 


1 roundness 


5 worm 


2 digging 


166 ground 


3 mother 




2 worms 



70 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



45. trouble: 



2 accident 


1 disagreeable 


3 health 


20 pain 


1 table 


4 affliction 


2 disagreement 


1 heart 


2 patience 


1 task 


3 aggravation 


1 disappoint 


1 heaviness 


2 patient 


9 tears 


6 anger 


3 disaster 


1 hemorrhage 


1 patients 


1 teasing 


6 angry 


7 discomfort 


2 home 


15 peace 


1 temper 


1 anguish 


2 discontent 


1 horror 


3 peaceful 


1 temptation 


1 annoy 


3 disease 


1 horse 


3 people 


2 thought 


2 annoyed 


2 dislike 


1 hurried 


1 perplexed 


1 thr>Ught8 


5 annoyance 


1 disobedience 


1 husband 


1 perplexity 


1 torment 


15 anxiety 


1 displeased 




3 person 


1 travel 


2 avoid 


1 displeasing 


1 idea 


1 pity 


1 trial 




2 displeasure 


2 illness 


10 pleasure 


3 trials 


11 bad 


1 dissatisfactory 


1 imaginary 


1 plenty 


5 troublesome 


1 begins 


7 distress 


2 inconvenience 


2 poor 




1 black 


2 disturbed 




2 poverty 


1 ngly 


1 borrowed 


1 doctor 


9 joy 


1 psychologist 


1 unavoidable 


1 borrows 


1 dogs 






1 uncertainty 


4 bother 




1 kindness 


3 quarrel 


2 uncomfortable 


2 bothered 


4 ease 


1 kinds 


3 quarreling 


6 uneasiness 


1 bothersome 


1 easiness 


- 


3 quiet 


6 uncaay 


1 brains 


1 easy 


1 labor 


1 quietness 


2 unfortunate 


1 brewing 


1 ended 


1 laugh 




13 unhappiness 


1 broke 


1 enemies 


1 lawyer 


1 release 


8 unhappy 


1 burden 


1 enemy 


1 lessons 


1 relief 


1 unlucky 


1 burdens 


1 error 


2 life 


1 remorse 


2 unnecessary 


1 business 


1 everyTvhere 


1 little 


1 rest 


5 unpleasant 


1 busy 


1 exams 


1 lonesome 


2 reverses 


3 unpleasantness 




1 excited 


1 loss 


1 Romeo 


1 unrest 


1 calm 


2 excitement 


5 lots 


1 ruffled 


1 unsafe 


1 calmness 








2 unsatisfactory 


27 care 


3 family 


2 mad 


6 sad 


1 unsettled 


3 cares 


1 father 


1 madness 


13 Badness 


2 upset 


1 careless 


3 fear 


5 man 


1 school 




4 children 


1 feeling 


1 many 


1 scrape 


1 want 


1 college 


1 few 


2 marriage 


1 sea 


2 war 


6 comfort 


5 fight 


2 me 


1 seldom 


1 weak 


1 comforts 


2 fighting 


10 mind 


1 sereneness 


3 weary 


1 comfortable 


1 flunking 


1 minded 


1 shadow 


2 weeping 


2 coming 


1 fret 


3 mischief 


1 ship 


1 welfare 


1 consequences 


1 friends 


1 miserable 


1 shootrngr 


1 woe 


2 contented 


1 fun 


14 misery 


47 sickness 


5 woman 


1 contentment 


1 funeral 


6 misfortune 


1 simple 


1 women 


1 court 


3 fuss 


1 misunder- 


1 sin 


8 work 


1 cry 




standing 


1 sleep 


1 worked 


1 crying 


2 girl 


4 money 


1 sometimes 


1 working 




2 gossip 


1 monotony 


202 sorrow 


3 worried 


6 danger 


2 great 


1 mother 


1 sorrows 


2 worries 


1 darkness 


26 grief 


1 Mrs. Wiggs 


4 sorrowful 


65 worry 


1 dav 




5 much 


1 sport 


1 worrying 


16 death 


1 handkerchief 




1 squabble 


5 worriment 


2 deep 


19 happiness 


1 nervousness 


1 study 


2 wrinkles 


2 despair 


8 happy 


3 no 


1 suffer 


2 wrong 


1 difficult 


5 hard 


2 noise 


1 suffering 




1 difficulties 


6 hardship 


4 none 


1 sweetener 


1 yesterday 


1 difficulty 


1 harm 


1 nuisance 


2 sympathy 


1 youth 



46. SOLDIER 



1 academy 


1 braveness 


1 colonel 


1 drums 


1 fortune 


1 armies 


8 bravery 


6 command 


4 duty 




137 army 


1 Brazilian 


1 commanding 




4 general 


3 arms 


1 brother 


3 commander 


1 enemy 


1 Germany 


1 Arnold 


2 buttons 


1 costume 


1 England 


1 glory 


2 artillery 




4 country 


1 English 


3 good 




4 cadet 


5 courage 


3 erect 


1 Grant 


1 baseball 


2 camp 






8 guard 


8 battle 


2 cannon 


1 danger 


1 fellow 


1 guardian 


1 bavonet 


1 cap 


2 defender 


17 fight 


1 guardsman 


1 blood 


8 captain 


1 defense 


1 fights 


27 gun 


1 blue 


3 cavalry 


2 discipline 


12 fighter 


2 guns 


23 boy 


14 citizen 


1 disliked 


12 fighting 




1 boys 


3 civilian 


1 double 


1 firearm 


1 helmet 


46 brave 


1 clothes 


2 drill 


2 fort 


8 hero 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



71 



1 him 


2 marshal 


5 patriot 


1 salute 


1 training 


1 hol» 


2 mechanic 


1 patriotic 


1 sentry 


1 travel 


1 home 


17 military 


1 patriotism 


1 servant 


1 troop 


1 hurt 


3 militia 


3 person 


1 service 


1 troops 




1 murder 


1 Philippines 


1 show 




2 infantry 


1 music 


1 police 


1 sick 


39 uniform 




2 miisket 


6 policeman 


1 single 


1 United States 


1 jacky 




1 protection 


1 smart 


3 upright 


1 Jim 


1 N. 


2 protector 


1 sorrow 


1 uprightness 




1 nation 


1 proud 


1 stateliness 




1 king 


1 national 




1 store 


1 valiant 




2 navy 


4 red 


3 straight 


3 veteran 


5 lieutenant 


1 necessary 


1 redcoat 


1 strength 


3 volunteer 




1 nobility 


1 regiment 


1 strenuous 




3 male 




2 regular 


1 strict 


94 war 


189 man 


1 obedience 


1 respectable 


4 strong 


1 warfare 


4 men 


1 obey 


1 Richmond 


2 sword 


12 warrior 


1 manly 


12 officer 


3 rifle 




3 West Point 


12 march 


1 officers 




2 tall 


2 widow 


5 marching 


1 order 


58 sailor 


1 tent 


2 work 


1 marine 


2 orderly 


1 sailors 
47. CABBAGE3 


4 tin 




1 away 


30 eat 


30 head 


3 onions 


2 soup 




6 eating 


1 heads 




4 sour 


1 bad 


6 eatable 


1 healthy 


1 paper 


1 spice 


2 beans 


3 eatables 


2 heavy 


1 parsley 


1 spinach 


11 beef 




1 herb 


16 patch 


1 sprouts 


1 beet 


11 farm 


1 home 


48 plant 


3 stalk 


2 beets 


1 farming 


2 horrid 


3 plants 


1 stew 


1 boiled 


3 field 




1 plantation 


1 stinking 


1 broth 


2 fields 


3 indigestion 


1 planted 


1 strong 


1 bud 


1 fine 




1 planting 


1 sustenance 


1 bunchy 


4 flower 


1 kale 


1 plate 


3 sweet 




22 food 


2 kraut 


5 pork 




2 carrot 


7 fruit 




5 potato 


3 taste 


1 carrots 




S large 


18 potatoes 


1 tender 


1 catsup 


43 garden 


9 leaf 


1 purple 


2 tomato 


17 cauliflower 


1 German 


11 leaves 




2 tomatoes 


1 cigar 


1 Germans 


11 letters 


1 quart 


20 turnip 


1 cold-slaw 


1 goat 


1 lot 




6 turnips 


1 cook 


13 good 




2 rabbit 




4 cooking 


44 green 


2 meal 


3 red 


1 unnecessary 


1 corn 


3 greens 


8 meat 


2 rose 


1 unwholesome 


1 cucumbers 


3 ground 


2 Mrs. AViggs 


4 round 




1 cut 


1 grow 


1 mustard 




1 Valhalla 




1 grows 




5 salad 


394 vegetable 


1 decayed 


2 growing 


1 nice 


17 sauerkraut 


10 vegetables 


1 disagreeable 


1 growth 


1 nothing 


2 slaw 


4 vinegar 


2 dish 






11 smell 


1 Virginia 


1 dislike 


1 ham 


2 odor 


1 soapy 




4 dinner 


3 hard 


2 onion 
48. HARD 


2 solid 


1 white 


2 adamant 


2 cabbage 


1 earth 


2 glass 


1 indestructible 


3 apple 


1 callous 


1 earthen 


1 glittering 


1 individual 


1 apples 


2 candy 


17 easy 


1 gold 


1 indurated 




1 can't 


2 egg 


2 good 


1 inflexible 


2 bad 


3 chair 


1 eggs 


1 granite 


1 injustice 


5 ball 


1 character 


1 examination 


2 ground 


1 irksome 


1 baseball 


7 coal 






44 iron 


1 bed 


1 coarse 


1 face 


1 hammer 




1 bench 


1 cold 


1 farmer 


2 harsh 


1 kind 


1 blackboard 


1 crj'stallized 


1 feary 


2 heart 




6 board 




4 feeling 


2 hearted 


1 labor 


2 boards 


1 dense 


11 firm 


2 heavy 


2 lead 


1 bone 


3 diamond 


2 firmness 


1 hickory 


2 lesson 


1 bread 


5 difficult 


1 fist 


1 hurt 


1 lignum-vitae 


1 break 


1 disagreeable 


4 flint 




2 life 


12 brick 


1 do 


Ifi floor 


8 ice 


1 low 


2 brittle 


1 durability 


1 formidable 


1 immovable 


3 luck 


2 bullet 




1 fruit 


1 impenetrable 





A STUDY OF ASSOCIATION IN INSANITY 



[July 



1 mai>lo 
3 marble 

1 mathematics 

2 mean 

2 medium 
T) metal 
1 murder 
1 nuish 

1 nail 
1 nailB 
1 natural 
1 nut 
1 nuts 

1 oak 
1 opaque 



2 pavement 
1 perplexing 
1 physics 
1 piano 
1 principle 
1 pulpy 

1 quality 

2 quest ionB 

1 raining: 
4 resistance 
1 resistant 
1 rigid 
1 road 
38 rock 
4 rocks 



1 rocky 
11 rouph 

1 saltpetre 
1 severe 
1 sidewalk 

15 smooth 
367 soft 

15 solid 
1 stale 

14 steel 
1 stick 
1 stingy 
102 stone 
1 stones 

1 atony 

2 stove 



1 strength 

4 strong 
1 stuff 

6 substance 

5 table 
1 tack 
1 thick 

1 tight 

2 touch 
12 tough 

2 tree 
1 trouble 
1 turnip 

5 unbreakable 
5 uncomfortable 



1 uneasy 

1 unimpression- 
able 

2 unpleasant 
1 unpliable 
1 unripe 

1 unyielding 
1 uselessnesa 

1 very 

1 walnuts 

2 water 

1 wisdom 
66 wood 
19 work 

2 working 



49. BAGLE 



3 air 


1 cruelty 


1 altitude 




7 America 


4 dollar 


12 American 


5 dove 


4 animal 




1 aspiring 


1 eggs 
8 emblem 


1 bald 


12 eye 


8 beak 


1 eyed 


2 beast 


1 eyry 


2 bill 


1 falcon 


568 bird 


7 feathers 


6 birds 


1 fierce 


1 birdie 


2 flag 
6 flies 


1 black 


1 butterfly 

2 buzzard 


22 flight 
1 flint 




46 fly 


1 carnivorous 


23 flying 


1 carrion 


2 flyer 

3 fowl 


1 chickens 


2 claws 


3 freedom 


1 clouds 




1 contour 


1 glare 


1 crag 


1 glorious 


3 crow 


2 golden 



1 graceful 
1 gray 
1 great 

13 hawk 
1 height 

21 high 

1 insect 
1 insignium 

1 keen 
4 king 

9 large 
1 lark 

1 liberty 

2 lofty 

2 might 

14 mountain 

3 mountains 

12 nest 

4 owl 



3 paper 
1 parrot 
1 partridge 

1 peacock 

2 pigeon 

2 power 
5 prey 

1 quail 
1 quarry 

1 robin 
1 rock 

1 scarce 

3 sharp 

1 sight 

2 sky 

2 sly 

5 soar 

3 soars 
14 soaring 

1 solitude 
1 space 

6 sparrow 
1 sport 



1 spread 
11 strength 
3 strong 
1 sun 

3 swallow 
1 swan 

4 swift 

1 swiftness 
1 sword 

1 talon 
1 talons 
1 tern 
1 Times 

1 turkey 

2 United States 

3 vulture 

8 wing 
16 wings 

1 young 

2 Zoo 



50. STOMACH 



32 abdomen 


3 cancer 


1 dress 


5 gastric 


2 internal 


31 ache 


1 care 


1 duodenum 


1 Gertrude 


28 intestine 


21 anatomy 


2 careful 


4 dyspepsia 


4 good 


32 intestines 


2 animal 


1 cat 




1 grind 




5 appetite 


1 cavity 


45 eat 


2 grinding 


1 juice 


1 apples 


1 chart 


27 eating 






2 arm 


18 chest 


8 empty 


2 hand 


4 large 




1 coil 


1 engine 


1 hands 


1 leg 


1 back 


2 condition 


1 excellent 


9 head 


1 limb 


1 bad 


1 contain 




5 health 


13 liver 


T bag 




1 face 


24 heart 


1 living 


1 basket 


1 delicate 


1 fat 


1 hog 


1 lung 


2 beast 


1 diapliragm 


1 feed 


6 hunger 


3 lungs 


1 beef 


6 digest 


1 feeding 


6 hungry 




6 belly 


1 digesting 


1 feet 


2 hurt 


1 machinery 


1 belt 


50 digestion 


102 food 


1 hurts 


5 man 


1 biology 


3 digestive 


2 foot 


1 hygiene 


1 meal 


99 body 


2 digests 


1 flesh 




1 meals 


13 bowels 


7 dinner 


1 frame 


1 illness 


5 member 


1 brain 


1 disease 


1 front 


17 indigestion 


1 milk 


1 bread 


1 distress 


7 full 


5 inside 


1 mortal 


1 breast 


2 doctor 


1 function 


2 interior 


3 mouth 
1 muscle 



I9IO] 


GRACE HKLEN 


KENT AND A 


.. J. ROSANOFF 


73 


2 nausea 


28 pain 


3 receptacle 


1 specimen 


5 troublesome 


3 necessary 


3 part 


2 reservoir 


1 strong 


1 trunk 


1 necessity 


9 person 


1 rest 


1 suffer 


3 tube 


1 neck 


3 physiology 


3 round 


1 suffering 




1 nuisance 


1 picture 




1 sustenance 


1 upset 




2 poor 


1 self 


2 system 


1 useful 


1 object 


1 portion 


10 sick 






1 oblong 


4 pouch 


7 sickness 


1 tender 


2 vessel 


4 oesophapis 


1 psychology 


1 skin 


1 tenderness 




81 organ 


3 pump 


2 small 


1 thought 


1 want 


3 organs 


2 punch 


4 soft 


1 throat 


1 water 


1 overeating 




1 sore 


2 tongue 


3 weak 


1 overloaded 


1 receiver 


2 sour 
51. STEM 


25 trouble 
1 troubles 


1 weakness 
1 work 


1 anything 


1 ending 


1 leg 


3 piece 


1 stiff 


1 appendage 


1 evolution 


3 length 


70 pipe 


1 stone 


43 apple 




1 lettuce 


1 pit 


1 stop 


1 apples 


1 fibre 


1 life 


74 plant 


1 storm 




2 fibres 


2 light 


1 plow 


2 straight 


1 base 


1 finger 


1 lilv 


6 point 


8 support 


3 beginning 


259 flower 


4 limb 


1 poppy 




1 blade 


7 flowers 


1 living 


1 projection 


4 thin 


3 blossom 


2 foundation 


18 long 


1 prop 


2 thorn 


1 boat 


14 fruit 






2 tide 


1 body 




1 match 


1 reed 


1 tobacco 


1 brain 


1 grass 




1 river 


1 top 


33 branch 


9 green 


1 necessity 


1 rod 


44 tree 


1 branches 


3 growth 




27 root 


2 trees 


1 broad 




1 object 


1 roots 


3 trunk 


1 broom 


20 handle 


1 offshoot 


21 rose 


7 twig 


4 bud 


1 hard 


1 organ 






5 bush 


1 head 




2 shank 


1 valve 


Ibutt 


2 hold 


4 part 


6 short 


1 violet 




1 holding 


1 parts 


7 slender 


3 vine 


2 cane 


4 holder 


1 particle 


1 small 




2 cherry 


1 holes 


2 peach 


1 smoke 


7 watch 


3 connection 




9 pear 


1 soft 


2 water 


1 connects 


1 join 


1 peduncle 


21 stalk 


3 weed 


2 cord 




3 pencil 


2 steps 


3 wind 


2 core 


96 leaf 


4 petal 


6 stem 


2 winding 




4 leaves 


1 pick 


14 stick 


3 winder 


10 end 








4 wood 







52. LAMP 






1 Aladdin 


1 crockery 


8 glass 


1 match 


1 shadow 


1 arc 




7 globe 




1 small 


6 articles 


1 dangers 




1 nickle 


4 smoke 




3 dark 


3 high 


4 night 


1 smokes 


5 black 


2 darkness 


1 home 




1 smoking 


1 blaze 


1 daylight 


1 hot 


49 oil 


1 smoky 


1 brass 


1 distance 


1 house 


1 ornament 


2 stand 


12 bright 


1 dull 






1 stove 


3 brightness 




2 illumination 


1 petroleum 


1 student 


20 burn 


5 electric 




5 post 




in burning 


1 evening 


7 kerosene 


1 pretty 


8 table 


3 burner 








1 tall 


1 burns 


5 flre 


1 lantern 


2 reading 






1 flame 


2 large 


1 red 


2 useful 


13 candle 


1 full 


1 library 


1 Rochester 




2 chandelier 


2 furniture 


650 light 


2 room 


2 vessel 


1 cheer 




2 lights 






37 chimney 


4 gas 


4 lighted 


2 see 


1 warmth 


1 convenience 


1 glaring 


1 lighten 

2 lit 


37 shade 


23 wick 
1 wisdom 



74 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



53. DRBAM 



1 absence 


1 eyes 


2 lie 


1 psychology 


1 stale 


1 angel 




1 like 


1 purple 


1 startling 


1 angels 


2 falling 


2 love 




1 story 


1 anger 


9 fancy 




1 queer 


14 sweet 


1 anything 


1 fantasy 


1 M. 


1 quiet 




(1 asleep 


1 fear 


2 man 




1 talk 


11 awake 


1 feeling 


1 mare 


1 realization 


1 terrible 


1 awaking 


1 feelings 


1 meditate 


1 recollection 


3 things 


1 awaken 


1 forgotten 


1 melancholy 


1 relax 


29 think 


3 awakening 


1 fortune 


1 melody 


1 remember 


8 thinking 




1 funny 


1 mesmeric 


2 repose 


38 thought 


2 baby 




8 mind 


1 reposing 


22 thoughts 


16 bad 


1 girl 


1 money 


3 rest 


1 tiring 


4 beautiful 


7 good 


1 music 


6 restless 


1 trouble 


11 bed 


1 goodness 




1 restlessness 


2 true 


3 bliss 


1 grand 


2 nature 


2 reverie 




1 book 


1 grieving 


1 never 




1 uncomfortable 


1 boy 




3 nice 


2 sad 


1 unconscious 




2 hallucination 


42 night 


1 sadness 


1 unconsciousness 


1 comfort 


3 happiness 


24 nightmare 


1 scene 


1 uneasiness 


2 consciousness 


1 heaven 


1 no 


1 second 


2 uneasy 


1 conversation 


3 home 


1 none 


1 semiconscious 


1 unfortunate 




1 hope 


2 nonsense 


1 sensation 


5 unpleasant 


1 dangerous 


3 horrible 




1 sense 


1 unpleasantness 


1 darkness 




1 object 


1 shade 


2 unreal 


1 days 


1 idea 


1 omen 


1 shadows 


2 unrest 


2 death 


3 illusion 


1 on 


1 short 


1 unstable 


1 delusion 


1 image 


1 opium 


2 sickness 




1 delusions 


2 imaginary 




1 sight 


1 vacancy 


1 disagreeable 


12 imagination 


1 paradise 


1 sights 


1 vagueness 


1 disappointment 


6 imagine 


1 patients 


339 sleep 


48 vision 


1 discontent 


1 imaginings 


1 peace 


39 sleeping 


6 visions 


2 disturbance 


2 impression 


2 peaceful 


2 sleeper 


1 vivid 


1 disturbing 


2 indigestion 


1 phantoms 


2 sleeplessness 




1 doze 


1 insanity 


3 picture 


2 sleepy 


9 wake 


1 dread 


1 inspiration 


1 pillow 


1 slept 


1 waking 


2 dreary 




1 play 


20 slumber 


1 wander 




1 kind 


38 pleasant 


1 something 


4 wandering 


1 easy 




13 pleasure 


1 somnambulist 


i weird 


1 expectation 


1 land 


1 presentiment 


2 snore 


9 wonder 


1 experiment 


2 languid 


1 prophesy 
54. YELLOW^ 


1 soliloquy 


1 woods 
1 work 


1 alive 


1 coarse 


9 flowers 


2 lily 


34 red 


2 amber 


301 color 


3 fruit 




1 ribbon 


3 apple 


1 coloring 




1 maize 


9 rose 


1 autumn 


1 common 


1 G. 


1 man 






1 complexity 


1 garments 


1 marigolds 


1 satin 


5 banana 


1 corn 


1 gay 


1 matter 


1 school 


3 beautiful 


2 cream 


1 glare 


1 mellow 


1 sear 


2 beauty 


1 crocus 


13 gold 


1 melon 


4 shade 


1 becoming 




5 golden 


1 molasses 


1 silk 


8 bird 


3 daffodil 


1 golflenglow 




2 sky 


24 black 


3 daflFodils 


5 goldenrod 


1 nature 


2 soft 


1 blossoms 


6 daisy 


1 goods 


1 nice 


1 spectrum 


41 blue 


7 dandelion 


1 gorgeous 




1 suit 


23 bright 


6 dark 


1 grass 


1 obnoxious 


1 sulphur 


2 brightness 


1 delightful 


41 green 


1 ochre 


21 sun 


1 brilliant 


1 desert 




47 orange 


8 sunflower 


13 brown 


1 disagreeable 


2 hair 




7 sunlight 


1 but! 


1 dog 


2 house 


5 paint 


1 sunshine 


7 butter 


1 door 


1 hue 


2 pale 




11 buttercup 


1 dream 




3 pansy 


1 table 


2 buttercups 


9 dress 


1 ink 


4 paper 


2 tan 


8 butterfly 


1 dresses 




2 peach 


1 tarnish 




1 dull 


2 jasmine 


1 pears 


1 tree 


4 canary 




3 jaundice 


1 pillow 


1 ugly 

1 unharmonious 


1 cat 

2 China 


1 ecru 
1 egg 


6 jealousy 
1 jonquil 


13 pink 
1 plague 


3 Chinaman 




2 journal 


1 poppy 


2 violet 


8 Chinee 


1 fade 




4 pretty 




2 Chinese 


1 fancy 


2 kid 


1 primrose 


1 wagon 


1 chrome 


1 fence 




2 pumpkin 


1 warm 


1 chrysanthemum 


3 fever 


2 leaf 


1 pumpkins 


1 warmth 


1 chrysanthe- 


4 flag 


1 leaves 


1 pure 


1 wax 


mums 


1 flame 


7 lemon 


5 purple 


1 wheat 


3 cloth 


38 flower 


14 light 




70 white 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



75 







66. BREAD 






1 appetite 


6 crust 


2 grain 


1 milk 


1 sour 




1 cut 




1 mixing 


8 staff 


2 bake 




1 ham 




3 stale 


4 baking 


3 daily 


1 hand 


1 necessary 


1 strengthen 


3 baker 


4 diet 


3 hard 


2 necessity 


2 substance 


1 bakery 


6 dinner 


2 heavy 


1 needful 


1 substantial 


14 biscuit 


1 dish 


1 holes 


4 nourishment 


1 sugar 


2 biscuits 


26 dough 


2 home 




1 sustenance 


4 blue 


1 doughnuts 


1 hot 


1 oatmeal 


4 sweet 


1 board 




7 hunger 






1 box 


1 earn 


4 hungry 


1 pantry 


3 table 


2 breakfast 


14S eat 




1 pastry 


2 tea 


3 brown 


44 eating 


8 knUe 


1 plate 


1 toast 


1 buns 


28 eatable 




1 pudding 


1 tough 


151 butter 


6 eatables 


23 life 








1 edible 


8 light 


' 1 roll 


1 useful 


15 cake 




1 living 


2 rolls 




1 cheese 


1 feed 


7 loaf 


6 rye 


9 water 


1 children 


88 flour 


1 lunch 




21 wheat 


1 color 


191 food 




1 salt 


15 white 


1 common 


3 fresh 


1 making 


1 salty 


1 wholesome 


1 cookies 


2 fruit 


2 man 


1 satisfaction 


1 wine 


1 corn 




1 meal 


1 sister 


1 winner 


1 crackers 


21 good 


5 meat 


8 soft 




1 crumbs 


2 graham 


56. JUSTICE 




8 yeast 


2 action 


3 do 


1 have 


1 merit 


4 satisfaction 


2 administered 


2 doing 


1 heaven 


1 mind 


1 satisfied 


1 administration 


1 done 


1 help 


1 moral 


I 8ati8f3Tng 


2 all 


1 Dr. E. 


1 him 


1 mother 


5 scales 


1 alwavs 


5 duty 


5 honest 




2 severe 


1 ask 




3 honesty 


1 never 


1 severity 


1 authority 


1 elusive 


7 honor 


1 nobility 


1 sorrow 




1 emblem 




1 noble 


3 square 


IB. 


1 employer 


1 impartial 


1 none 


1 squareness 


1 bad 


1 energy 


1 iniquity 


1 nonsense 


1 squire 


1 bed 


3 equal 


1 injury 




4 statue 


3 blind 


9 equality 


26 injustice 


1 obey 


1 story 


1 blindfolded 


1 equally 


I innocent 


1 obtain 


3 supreme 


Ibody 


3 equity 




1 oppression 


2 sure 




2 even 


1 J. 


4 order 




1 cauffht 


1 exactness 


2 jail 




1 tranquility 


1 charity 


1 execution 


1 joy 


1 pardon 


6 true 


1 chastise 




91 judge 


4 partiality 


14 truth 


1 chief 


32 fair 


1 judged 


143 peace 


2 truthfulness 


1 clearness 


21 fairness 


6 judgment 


1 perfect 




1 comfort 


1 favor 


3 jury 


1 person 


1 unbias 


3 command 


1 fear 


5 just 


1 picture 


1 unfairness 


1 commanding 


1 fine 


4 justified 


1 Plato 


1 unhappiness 


1 conqueror 


6 freedom 




1 police 


3 unjust 


1 constable 


1 friendship 


6 kindness 


1 policeman 


1 uprightness 


64 court 






1 politics 




2 courts 


1 gift 


1 lacking 


1 popular 


1 vengeance 


1 Creator 


1 give 


1 large 


1 power 


3 virtue 


1 crime 


3 given 


74 law 


1 privilege 




1 criminal 


3 God 


2 lawful 


1 purity 


2 well 


2 cruelty 


1 godliness 


4 lawyer 




1 wicked 




14 good 


2 lenient 


1 reason 


1 willingness 


1 dealing 


2 goodness 


11 liberty 


2 reward 


2 wisdom 


1 deeds 


1 govern 


1 lots 


157 right 


1 wise 


1 defying 


3 government 


1 love 


3 righteous 


2 work 


1 delayed 


1 gxiilty 




13 righteousness 


8 wrong 


1 demand 




2 magistrate 


1 rightly 




1 deserved 


1 happy 


13 man 


1 Tightness 


1 yea 


2 dispute 


1 harm 


1 merciful 


11 rights 


1 yield 


1 distribution 


1 hastv 


28 mercy 


1 niler 





76 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







57. BOY 






2 action 


1 dog 


1 incorrigible 


1 mother 


3 son 


2 active 




1 industrious 


1 muscles 


1 spirit 


2 activity 


1 Edward 


2 infant 


1 myself 


1 spoiled 


1 a^lity 


1 eighteen 


1 inhabitant 




2 sport 


3 animal 


1 embryonic 


1 innocent 


1 naughty 


1 street 


3 athletic 


1 errand 




2 Ned 


2 strength 


2 athletica 




1 jacket 


1 nephew 


3 strong 




1 fair 


2 James 


1 newspaper 


2 suit 


fi baby 


3 female 


1 Jimmy 


3 nice 


1 sweetheart 


bad 


1 fight 


1 Joe 


7 noise 


1 swimming 


10 hall 


1 flesh 


1 joyful 


3 noisy 




1 barefoot 


1 foolish 


1 jump 


1 nuisance 


3 tall 


5 baseball 


1 football 


1 jumper 




1 terror 


1 beautiful 


1 Frank 


2 juvenile 


I obedient 


1 think 


6 being 


4 friend 




1 out 


1 Thomas 


IBen 


2 frolic 


4 kid 




2 top 


2 body 


4 fun 




6 pants 


1 toys 


1 boisterous 


1 funny 


7 lad 


1 Paul 


1 Tracy 


1 book 




2 large 


11 person 


1 trait 


2 bripht 


1 games 


1 laugh 


20 play 


1 tramp 


6 brother 


319 girl 


1 legs 


1 plays 


1 trouble 


2 busy 


7 good 


2 life 


1 plaj-ful 






1 grown 


3 little 


1 playfulness 


1 useless 


1 cap 


1 growth 


3 lively 


2 pupil 




1 careless 


2 gim 






1 walk 


1 Charles 




1 maid 


6 rough 


1 water 


1 chicken 


1 handsome 


63 male 


1 nmning 


1 whistle 


86 child 


1 Harry 


104 man 


1 runs 


1 whistles 


1 children 


1 hat 


1 manhood 




1 wicked 


I class 


1 head 


1 mankind 


1 scallywag 


2 wild 


1 clothes 


1 hearty 


1 manliness 


2 scamp 


1 wildness 


1 clothing 


1 hero 


1 manly 


1 scholar 


2 woman 


2 companion 


2 hood 


1 marbles 


11 school 


1 woods 


1 cousin 


2 hoop 


3 masculine 


4 sex 


1 work 


1 curls 


9 human 


2 master 


1 sharp 


1 working 




1 humanity 


1 meanness 


2 shoes 




1 dead 




1 Michael 


14 small 


22 young 


1 development 


1 imbecile 


11 mischief 


2 smart 


1 youngster 


2 dirty 


1 imperfect 


7 mischievous 
58. LIGHT 


1 smiles 


33 youth 
1 youthful 


1 agreeable 


231 dark 


1 glare 


7 morning 


1 s-gn 


8 air 


93 darkness 


1 gleam 




8 skv 


1 airy 


2 dawn 


3 good 


1 nice 


1 soft 


1 arc 


SI day 




3 night 


1 sound 


1 assistance 


2 daylight 


2 hair 


1 necessity 


1 space 


1 awake 


6 daytime 


4 happiness 




1 splendor 




1 dimness 


1 health 


1 paper 


1 steam 


1 beacon 


1 distance 


1 healthy 


1 pathway 


85 sun 


2 beautiful 


1 dress 


1 hearted 


1 peaceful 


1 sunlight 


1 beautifying 


1 dull 


8 heat 


1 pink 


11 sunshine 


1 beauty 




1 heaven 


1 pipe 


1 swift 


1 biscuit 


2 early 


5 heavy 


1 placid 




3 black 


1 easy 


1 hills 


3 pleasant 


1 transparent 


2 blue 


1 education 




1 pleasure 


1 truth 


1 bread 


7 electric 


1 illuminate 


1 plenty 


1 twilight 


47 bright 


8 electricity 


7 illumination 






21 brightness 


1 element 




2 rays 


1 ventilation 


3 brilliant 


1 emptiness 


1 joy 


1 red 


1 Vera 


1 brown 


1 enjoy 




1 reflection 


1 vibration 


2 bum 


1 evening 


1 kerosene 


1 right 


2 vision 


1 burning 


1 eyes 


1 knowledge 


3 room 


1 vivid 
1 waist 


3 candle 


1 fair 


1 laboratory 


24 see 


2 warmth 


1 cheer 


6 feather 


82 lamp 


3 seeing 


1 waves 


2 clear 


1 feathers 


1 lamps 


1 seen 


1 weak 


2 clearness 


6 fire 


7 life 


8 shade 


2 weight 
8 white 


2 coat 


1 flame 


1 long 


2 shadow 


19 color 


1 fleshy 


1 look 


1 shadows 


2 whiteness 


2 comfort 


1 forward 


1 luminous 


2 shine 


15 window 


1 complexion 


1 fuel 




2 shines 


1 world 


1 convenient 




1 match 


2 shining 




1 cork 


21 gas 


10 moon 


3 sight 


6 yellow 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



77 



B9. HEALTH 



1 action 


3 desirable 


111 happiness 


1 optimism 


5 sound 


2 activity 


9 disease 


7 happy 




1 spirit 


9 air 


4 doctor 


1 haste 


1 pain 


1 spirits 


1 athletics 




1 healing 


8 perfect 


1 state 




1 eatinp: 


1 healthful 


6 person 


112 strength 


5 bad 


5 enjoj-nient 


1 healthy 


3 physical 


1 strengths 


1 baseball 


2 everything 


1 heaven 


1 physician 


31 strong 


1 beautiful 


1 excellent 


2 holiness 


1 physiology 


1 sturdy 


10 beauty 


1 excursion 


2 hygiene 


1 play 


1 success 


1 better 


3 exercise 




2 pleasant 




4 blessing 


1 existence 


3 ill 


14 pleasure 


1 temper 


1 blood 




13 illness 


1 plenty 


2 thankful 


1 board 


1 face 




2 poor 


1 trouble 


9 body 


2 feel 


6 joy 


1 preserve 




1 boon 


12 feeling 




1 proper 


1 unhealthiness 


2 boy 


1 fine 


5 life 


4 prosperity 


3 unhealthy 


1 broad 


4 food 


1 light 




2 useful 


2 buoyancy 


1 form 


1 live 


1 quick 






2 fortune 


3 living 




1 valuable 


1 care 


1 freedom 


2 luck 


1 red 


11 vigor 


1 careful 


1 fun 


1 lux\iry 


3 riches 


1 Wrility 


1 cheer 






9 robust 




1 circulation 


3 gift 


4 man 


1 rose 


1 walking 


1 cleanliness 


1 girl 


1 me 


S rosy 


2 want 


1 climate 


2 gladness 


3 medicine 


1 round 


1 warm 


1 color 


1 glow 


1 merriment 


2 rugged 


1 water 


26 comfort 


1 golf 


1 mother 




1 weakness 


6 condition 


94 good 


1 mountain 


1 self 


76 wealth 


1 constitution 


1 goodness 


1 moving 


9 sick 


63 well 


1 consumption 


2 grand 




2 sickly 


1 wholesome 


1 contentment 


1 g>Tnnasium 


1 necessary 


153 sickness 


1 woman 


1 convenience 


1 g>'mnastic8 


1 needed 


1 smiles 


1 wonderful 


2 country 




1 needful 
4 normal 

60. BIBLG 




1 youth 


1 academy 


1 encyclopedia 


1 Jacob 


1 paper 


1 sour 


1 all 


1 excellent 


4 Jesus 


1 piety 


1 stones 


■ 1 ancient 




2 knowledge 


2 pious 


2 stories 




1 fable 


1 Koran 


3 pray 


4 story 


1 beauty 


1 faith 




2 praying 


1 strength 


1 belief 


2 family 


4 large 


19 prayer 


2 studies 


1 beneficial 




3 law 


7 prayers 


6 study 


2 black 


1 Genesis 


1 leaf 


13 prayer-book 


6 Sunday 


338 book 


1 glass 


1 leaves 


2 preacher 




1 books 


43 God 


1 lectern 


1 preaching 


3 table 




28 good 


1 legend 


1 prophet 


1 teach 


1 catechism 


12 goodness 


2 lie 


4 psalms 


1 teacher 


8 Christ 


3 gospel 


3 life 




1 teachings 


3 Christian 


1 gospels 


2 light 


1 rarelv 


24 Testament 


50 church 


1 grand 


2 literature 


31 read 


4 text 


3 class 


1 guide 


5 Lord 


19 reading 


1 tradition 


1 clean 




2 love 


1 reformation 


2 true 


1 clefgj-man 


2 heaven 




89 religion 


17 truth 


2 comfort 


1 heavy 


1 message 


4 religious 


1 truthfulness 


2 command 


1 help 


1 mine 


1 reverence 




1 commandment 


26 history 


3 minister 


1 righteous 


1 unnecessary 


2 commandments 


5 holiness 


2 Moses 


3 rot 


2 useful 


1 creed 


57 holy 


1 mother 








2 home 




3 sacred 


1 verses 


1 devotion 


1 hope 


1 necessary 


2 Saviour 




1 directions 


2 hymns 


1 noble 


2 school 


1 weariness 


1 drama 






17 scripture 


8 word 


2 duty 


1 instructive 


2 obey 


3 scriptm-es 


1 words 






1 open 


1 sermon 
1 shelf 


2 worship 
1 writ 



-8 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



2 absent 
1 acquire 
1 aid 
1 analysis 

1 ancient 

2 association 
1 attention 

1 attitude 
1 aunt 

1 back 
19 bad 

1 beautiful 

1 bird 

3 blank 

2 book 

3 books 
46 brain 

5 brains 
1 brightness 
1 bucket 

1 catechism 
1 cause 
1 charming: 

4 childhood 

1 clear 

2 concentration 
1 connection 

1 conscience 

2 consciousness 

1 dancing 
1 death 

1 debts 

2 defect 

1 defective 
1 desirable 
1 deterioration 
1 dictionary 
1 dim 
1 distant 
1 dream 

3 dreams 

a dull 

1 easy 
1 educated 
1 eflfort 
1 elusive 



225 animal 
18 animals 
1 astray 
1 awkward 

1 baa 

3 beast 

1 bed 

1 Bethlehem 

5 hi nek 

1 blind 

1 buffalo 

1 calf 

1 calm 
47 cattle 

1 cloth 

3 coimtry 
22 row 

5 cows 

1 death 

2 deer 
2 dirty 

6 dof? 
2 dogs 



1 English 

1 Europe 

2 events 

1 everything 

2 excellent 

1 experiment 

1 faces 
1 faculty 
1 failing 
1 fails 

4 fair 

1 fancy 
1 far * 
1 farther 
1 fascination 
1 faulty 
1 feeling 
1 fine 
1 fleeting 
1 fond 
1 fool 
25 forget 

5 forgetful 

37 forgetfulness 
5 forgetting 

3 forgotten 
1 forty 

1 friends 

2 gone 
68 good 

1 gravestone 

1 great 

2 green 

1 happiness 
1 happy 
9 head 

1 hearing 

2 history 
2 home , 

1 hopefulness 

2 idea 

1 image 

2 imagination 
1 impossible 

1 increase 
7 intellect 



1 eat 



61. MEMORY 

5 intelligence 
1 interpret 
1 invisible 



1 joy 

1 keep 

1 know 

4 knowledge 

2 lack 

2 lacking 
1 language 
1 lasting 

1 learn 

2 learning 
1 lecture 

1 length 

2 lessons 
1 light 

3 long 
1 loss 
1 love 

1 magnificent 

3 man 

1 marvelous 
1 me 

1 memorandum 
1 memorizing 

4 mental 
138 mind 

1 mindful 

2 mnemonics 
1 mother 

1 mud 
1 my 
1 myself 

1 names 

3 necessary 
1 necessity 
1 needful 

1 noble 
1 none 

1 oblivion 

1 painful 
8 past 

«3. SHEEP 

1 group 



4 farm 


1 hair 


1 feed 


1 harmless 


12 field 


4 herd 


6 fields 


1 herder 


3 fleece 


T hill 


1 flesh 


2 hillside 


24 flock 


1 horn 


1 flocks 


1 horse 


4 fold 


1 humanity 


1 follow 




2 food 


5 innocence 


1 foolish 


2 innocent 


1 fowl 




1 fur 


1 Jump 


1 gentle 


151 lamb 


1 gentleness 


36 lambs 


1 goad 


1 landscape 


17 goat 


2 large 


in gnats 


1 lecture 


2 good 


1 lowing 


4 grass 




1 graze 


1 many 


5 grazing 


3 meadows 



1 patient 

1 pen 

2 perception 
2 person 

2 picture 
1 pictures 

1 pleasantness 

2 pleasure 

3 poem 
1 poems 
7 poetry 

23 poor 
1 power 
1 psychology 

1 quick 

1 reading 

1 reason 

4 recall 

2 recalling 

3 recognition 

2 recollect 

16 recollection 

3 recollections 

1 reflect 

27 remember 

4 remembering 
18 reniembraiice 

2 remind 

1 reminder 

2 reminiscence 
1 reminiscences 
1 reproductive 

1 result 

1 retain 

2 retaining 

5 retention 

3 retentive 
1 retrospect 

1 sadness 
1 scenes 
1 scholar 

6 school 

1 sensation 
5 sense 

2 senses 

7 short 

1 simple 



5 meat 
1 meekness 
3 mountain 
60 mutton 

1 nature 

1 oxen 

2 park 
27 pasture 

3 pastures 
1 peace 

1 peaceful 
1 pet 

1 picture 

2 pig 

1 plains 

1 play 

4 pretty 

2 quadruped 

1 raising 
1 ram 



1 song 

2 sound 

1 splendid 

1 stanza 

1 storehouse 

1 story 

1 i^trengthen 

1 strong 

1 student 

4 study 

1 studying 
1 sure 

7 sweet 
1 swift 
1 swing 

1 teacher 
1 tender 

5 test 

1 thankful 

1 things 
58 think 
38 thinking 

1 thinks 
81 thought 
28 thoughts 

8 thoughtful 

3 thoughtfulness 
1 thoughtlessness 
1 time 

1 train 
1 training 
1 tree 

1 unconsciousness 
3 understand 

6 understanding 

1 unstable 

2 useful 

2 verses 

1 weak 
1 well 
1 will 
1 wit 

1 wonderful 

2 work 

2 youth 



1 rocks 

1 run 

1 running 

1 shear 
1 shearing 

1 shears 
15 shepherd 
1 simple 

1 sleep 

2 small 
1 soft 

1 spring 

2 stock 

1 stupidity 

1 tick 
1 trust 

1 wander 

1 water 
18 white 

2 wolf 
143 wool 

10 woolly 



I9IO] 


GR,\CE HELEN 


KENT AND A. 
63. BATH 


J. ROSANOFF 


7! 


1 baby 


1 dry 


2 invigorating 


2 pleasure 


1 springs 


1 basin 






2 plenty 


10 swim 


2 bathe 


1 English 


1 joy 


3 plunge 


5 swimming 


6 bathing 


1 every 




1 porcelain 




1 beneficial 




1 large 




1 take 


1 boat 


1 flith 


1 luxury 


1 refreshed 


1 taken 


1 boy 


1 fllthiness 




6 refreshing 


2 toilet 




1 fine 


1 man 


1 refreshment 


6 towel 


120 clean 


1 flowers 


1 massage 


2 river 


2 towels 


1 cleaning 


1 fluid 


2 morning 


3 robe 


71 tub 


109 cleanliness 


2 fresh 




6 room 




2 cleanly 




1 nakedness 




1 vapor 


9 cleanness 


7 good 


1 neatness 


1 salt 


1 vessel 


6 cleanse 




6 necessary 


1 sanitary 




8 cleansing 


9 health 


2 nice 


1 scrub 


1 want 


14 cold 


1 healthful 


1 none 


1 sensation 


3 warm 


3 coTiifort 


1 healthiness 




3 shower 


102 wash 


3 cool 


4 healthy 


6 ocean 


1 sleeping 


16 washing 


1 Creal Springs 10 hot 


1 often 


13 soap 


339 water 




4 house 


1 once 


1 soothing 


5 wet 


1 delight 






1 sponge 


1 wood 


4 dirt 


1 invigorates 


3 pleasant 


4 spray 




6 dirty 








2 yesterday 



64. COTTAGE 



2 abode 


2 door 


1 ivy 


1 patients 


1 simplicity 


1 aRTeeabie 


23 dwelling 




1 peace 


1 sleep 


1 alone 




5 lake 


1 people 


30 small 


1 apartments 


2 family 


1 lane 


1 picturesque 


1 snug 




1 far 


1 large 


1 place 


1 stands 


2 barn 


4 farm 


4 lawn 


1 pleasantness 


3 structure 


1 beach 


1 fence 


4 little 


1 pleasure 


9 summer 


1 beautiful 


6 field 


17 live 


1 pond 


1 sweet 


1 box 


2 fine 


5 living 


4 porch 


1 Switzerland 


3 brick 


4 flowers 


1 log 


1 prettinesa 




1 brook 


2 frame 


1 lonesomeness 


3 pretty 


1 table 


2 brown 




4 love 


1 pudding 


4 tent 


31 building 


7 garden 


2 low 




2 thatched 


13 bungalow 


3 green 


1 lumber 


1 reside 
4 residence 


1 tower 
1 trees 


3 cabin 


1 habitable 


1 Maine 


1 resident 


3 two 


1 carap 


3 habitation 


15 mansion 


1 resort 




2 camping 


1 hamlet 




3 rest 


1 unity 


1 Cape Cod 


1 hammock 


1 name 


1 river 


^ vfipafifin 


2 castle 


1 handsome 


3 neat 


1 rod 


1 veranda 
1 villa 


1 chair 


5 happiness 


1 Newburgh 


3 roof 


1 cheese 


1 happy 


4 nice 


1 roomy 


3 village 
1 vine 


3 city 


3 hill 




2 roses 


15 comfort 


85 home 


2 one 


1 rustic 


3 vines 


2 contentment 


1 homelike 


1 open 




1 cottage 


1 homestead 


1 orchard 


1 school 


3 white 

9 viri n r1 nvr 


36 country 


1 hope 


1 outing 


10 sea 


2 couple 


1 hospital 




5 seashore 


1 woman 
11 wood 
1 wooden 


2 cozy 


461 house 


1 painted 


2 seaside 


1 cute 


1 houses 


2 palace 


6 shelter 






2 parsonage 


2 shingles 


3 woods 


1 distant 


1 innocence 


1 patient 


2 shore 





1 yard 



8o 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



2 active 


7 deer 


2 aeroplane 


1 degree 


1 ahead 


1 doctor 


1 antelope 


2 dog 


13 arrow 




11 automobile 


8 eagle 


1 autos 


2 easy 




3 engine 


6 ball 




1 beauty 


222 fast 


1 better 


1 fastness 


1 bicycle 


1 fear 


16 bird 


1 fish 


1 birds 


5 Heet 


1 boat 


6 fiieht 


1 brisk 


3 flv 


1 brook 


3 flying 


3 bullet 


1 foot 


1 cat 


1 girl 


1 cbaDDel 


1 go 


1 child 


1 going 


1 choice 


1 good 


1 clever 


1 grand 


1 creek 


1 Greek 


7 current 




1 curve 


1 hard 


1 cutting 


1 hare 




1 haste 



05. SWIFT 






1 hear 


1 near 


4 slowly 


1 hiph 


1 Niagara Falls 


16 smart 


28 horse 




1 smartness 


12 hurry 


1 power 


3 smooth 


1 hurrying 


117 quick 
13 quickly 


2^ speed 




1 speedily 


1 Indian 


5 quickness 


1 speeding 
7 speedy 
1 spinchiled 


1 kite 


1 quiet 




6 race 


2 spry 


1 launch 


27 rapid 


1 steam 


1 lazy 


2 rapidity 


1 sting 


2 light 


2 rapidly 


1 stone 


4 lightning 


1 real 


8 stream 


3 lively 


1 riding 


2 strong 




18 river 


2 sure 


1 man 


1 rivers 


5 swallow 


1 Marathon 


1 road 


1 swallows 


1 Mercury 


1 rocket 




1 messenger 


19 run 


1 throw 


1 meteor 


20 running 


2 tide 


1 more 


13 runner 


1 time 


1 morning 


1 rushing 


18 train 


2 motion 




1 traina 


1 motoring 


1 sail 




2 movement 


1 sharp 


1 walking 


1 moving 


1 shot 


11 water 


1 muscles 


1 sleigh 


8 wind 




1!)0 slow 


1 work 







66. blue: 






1 air 


1 cold 


1 good 


1 necktie 


1 skies 


1 azure 


256 color 


2 grass 




239 sky 




2 colors 


10 gray 


12 ocean 


1 soft 


Iball 


2 coloring 


54 green 




1 somber 


1 beautiful 






3 paint 


1 space 


1 becoming 


1 dainty 


1 hat 


1 pale 


1 stripes 


1 bell 


24 dark 


5 heaven 


1 paper 


1 suit 


1 binding 


5 deep 


2 heavens 


1 pencil 




6 bird 


1 depth 


1 heavenly 


9 pink 


2 tie 


38 black 


18 dress 


1 homesick 


2 pleasant 


1 tint 


1 blood 


1 dull 


1 hopeful 


1 pleasing 


7 true 


1 blossom 




1 horizon 


1 policeman 


2 truth 


1 blotter 


1 ether 


1 house 


4 pretty 


1 turquoise 


1 bluebird 


6 eyes 


1 hue 


1 purity 




2 bluing 






2 purple 


1 unhappy 


1 blusey 


1 fair 


5 indigo 




1 unrest 


1 book 


4 feeling 


6 ink 


64 red 


1 velvet 

2 violet 


5 bright 


1 fidelity 




1 restful 


8 brown 


6 flag 


1 lake 


3 ribbon 




3 flower 


8 light 


1 river 


3 violets 


1 cadet 


1 forget-me-not 


1 lily 


1 room 


2 washing 


1 chemical 




1 lonesome 




8 water 


1 clock 


1 gentian 




2 sad 


47 white 


7 cloth 


1 globe 


2 melancholy 


1 sailor 


2 wind 


3 clothes 


2 gloominess 


1 Monday 


7 sea 




1 clothing 


2 gloomy 




1 serge 


2 Yale 


1 cloud 


1 glum 


1 navy 


2 shade 


27 yellow 



67. HUNGRY 



1 aching 
1 ambitious 

1 angry 

2 animal 

1 appeasing 
67 appetite 



2 appetizing 

2 baby 

3 bad 

1 bananas 
1 bear 



4 beggar 
1 biscuit 

5 boy 
26 bread 

3 breakfast 
1 butcher 



1 candy 
5 child 
5 children 
4 cold 
1 college 
1 country 



1 crackers 
1 crave 
7 craving 
1 cupboard 

1 dark 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



8l 



1 desirable 


4 fatigue 


U desire 


1 fatigued 


1 devil 


4 fed 


1 devour 


1 feel 


31 dinner 


8 feeling 


1 disagreeable 


1 fill 


4 discomfort 


4 filled 


1 displeasure 


130 food 


1 dissatisfaction 


1 form 


1 dissatisfied 


1 fulfilment 


1 distress 


9 full 


14 doj 


3 fruit 


1 dogs 




1 dry 


1 gaunt 




1 Gertrude 


[26 eat 


1 girl 


64 eating 


2 gnawing 


2 eatables 


1 good 


1 emotion 


1 grub 


4 emptiness 




13 empty 


1 hardship 


2 exhausted 


I Henrietta 




1 ho? 


9 faint 


1 horse 


1 taintinir 


2 hunger 


5 famine 




1 famish 


3 I 


11 famished 


1 ice-cream 


1 famishing 




1 fascinating 


1 kitchen 


3 fast 




5 fasting 


2 lack 



1 lion 


1 perishing 


2 steak 


5 longing 


2 person 


13 stomach 


4 lunch 


2 picnic 


1 suffering 




2 pie 


1 sufficiency 


5 man 


2 plenty 


1 sufficient 


4 me 


1 plow 


2 supper 


1 meal 


6 poor 




3 meat 


1 potatoes 


1 table 


1 milk 


2 poverty 


12 thirst 


2 miserable 


1 present 


61 thirsty 


1 misery 




1 thought 




1 ravenous 


1 tiger 


1 nausea 


1 repletion 


12 tired 


1 necessary 




1 tiresome 


2 need 


1 sad 


3 tramp 


1 needy 


2 sandwiches 


1 traveling 


1 never 
1 nice 
1 no 


3 satiated 
2 satiety 
14 satisfied 


1 uncomfortable 
1 unhappiness 
4 imhappy 
4 unpleasant 


1 noon 
1 nothing 


2 satisfy 
1 school 


1 nourish 


1 sensation 


3 unsatisfied 


2 now 


1 sharp 


1 very 




1 ship 


1 viands 


1 ocean 


1 sick 


1 victuals 


1 often 


1 sleepy 






1 slow 


1 walk 


5 pain 


2 sorrow 


25 want 


1 painful 


10 starvation 


5 wanting 


1 pallid 


8 starve 


5 weak 


1 pang 


15 starved 


3 weakness 


1 peaches 


29 starving 


2 wish 
10 wolf 



68. PRIEST 



3 altar 


1 conscientious 


2 heaven 


12 nun 


8 robes 


1 authority 


1 console 


1 high 


1 ofiice 


1 ruler 




1 counsellor 


3 holiness 




i belief 


1 crucifix 


15 holy 


11 parson 

11 pastor 

1 people 

3 person 
1 piety 

4 pious 
3 Pope 
1 power 
1 praise 


2 sacred 


3 Bible 




2 honor 


1 sacrifice 


6 bishop 


1 dignified 


2 hood 


1 sanctity 


13 black 


2 discipline 


1 house 


1 school 


1 blessing 


1 discontent 


1 humble 


1 sent 


1 book 


1 dishonor 


2 hypocrite 


1 serious 


1 boy 


1 diplike 




3 sermon 


1 brother 


1 divine 


1 inspired 


1 sermony 




1 divinity 


1 instruction 


2 servant 


1 cassock 


5 doctor 




3 pray 
1 prays 
8 prayer 

1 prayers 
3 preach 

2 preaches 
35 preacher 

2 prelate 


2 service 


2 cathedral 


1 doing 


2 Jew 


1 services 


36 Catholic 


1 dominie 


1 just 


2 shaven 


2 Catholics 


1 dress 


1 justice 


1 shoot 


4 Catholicism 


1 Dr. K. 




1 sinner 


1 ceremony 


1 duty 


1 kind 


1 sister 


1 chancel 




1 knowledge 


1 slim 


2 chapel 


1 exalted 




1 solemnity 


1 childhood 




2 layman 


2 priestess 

1 profession 

3 prophet 

1 pulpit 

2 purity 


1 sometimes 


166 church 


2 faithful 


4 leader 


1 spookism 


1 clean 


2 fakir 


1 lecture 


1 stern 


30 clergy 


1 fakirs 


1 Levi 


1 student 


62 clergyman 


3 fat 


2 Levite 


2 Sim day 


1 cleric 


15 father 


1 Lord 


3 surplice 


2 clerical 


1 follower 




2 rabbi 




1 cloister 


1 forgive 


5 male 


57 religion 


1 table 


1 cloth 


1 forgiveness 


75 man 


7 religious 


2 teacher 


1 clothes 




5 ma^s 


1 representative 




1 collar 


2 garb 


178 minister 


1 repulsive 


1 ugly 


1 comforter 


1 E'entleman 


5 monastery 


1 reserved 




1 command 


2 God 


9 monk 


1 reverend 


1 vest 


1 communion 


9 good 


1 moral 


2 righteous 


1 vicar 


5 confession 


1 goodness 




I road 




2 confessor 


6 gown 


1 noble 


12 robe 


1 York 



82 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







69, OCEAN 








1 afraid 


1 crossing 


1 Hudson 


12 rough 


2 


swim 


1 an pry 


1 current 






1 


s%vimming 


11 Atlantic 




1 immense 


2 sail 








1 dark 


2 immensity 


2 sailing 


1 tide 


1 barge 


87 deep 


2 infinity 


10 salt 


1 terrible 


3 bathing 


1 deepness 


2 joy 


2 sand 


1 traveling 


3 bay 


m depth 


1 Sandy Hook 




trip 


5 beach 


1 depths 


12 lake 


75 sea 






1 beautiful 


2 distance 


8 land 


3 seas 




vallev 


5 big 




9 large 


2 seashore 




vast 


1 bigness 


1 enormous 


1 launch 


1 seething 




vast n ess 


1 billows 


1 Europe 


1 liquid 


1 shining 




vessel 


25 blue 


2 expanse 




24 ship 




voyage 


6 boat 


1 expansive 


1 Maine 


11 ships 






1 boats 




1 Mauretania 


2 shore 




waste 


2 body 


1 float 


I might 


1 sky 


427 


water 


1 boisterous 


2 foam 


3 mighty 


1 sound 




waters 


3 breadth 




2 motion 


1 storm 


12 


wave 


1 breeze 


2 grand 


1 power 
1 pretty 


1 storms 


45 


waves 


3 broad 


2 grandeur 


1 steamboat 




wavy 


1 Byron 


3 great 


14 steamer 




wet 




1 greatness 


1 quantity 


1 steamers 




white 


1 Cape Cod 


2 green 




1 steamship 


In 


wide 


2 Coney Island 


2 Grove 


36 river 


4 stream 




wonder 


1 country 


1 gulfs 


1 roars 


1 swiftness 


1 wonderful 







70. HBAD 






1 above 


1 combs 


3 good 


14 man 


4 scalp 


9 ache 


1 consciousness 


1 govern 


1 man's 


3 sense 


1 aches 


1 cover 


1 great 


1 masterpiece 


1 senses 


8 anatomy 


1 covered 




1 medium 


1 sensible 


2 animal 


2 cow 


159 hair 


7 member 


4 shape 


1 appearance 


11 cranium 


11 hand 


3 memory 


1 shaped 


2 arm 


1 crown 


2 hands 


1 mentality 


1 shoulder 


3 arms 




1 handsome 


14 mind 


12 shoulders 


1 asymmetrical 


1 director 


2 hard 


1 mouth 


5 skull 




1 donkey 


17 hat 




7 small 


1 baby's 




1 headless 


1 nail 


2 sore 


2 back 


1 ear 


8 heart 


1 nation 


1 square 


1 bald 


1 ears 


2 heels 


17 neck 


2 statue 


1 ball 


1 emptiness 


3 high 


2 nose 


2 stomach 


1 beautiful 


1 empty 


2 highest 




1 strong 


1 beginning 


1 encephalon 


2 hot 


5 organ 


2 superintendent 


5 big 


1 end 


1 house 




1 symmetry 


1 black 


1 extremity 


4 human 


1 pain 




46 body 


2 e,i'e 




6 part 


3 tail 


1 bonehead 


10 eyes 


1 individual 


1 people 


1 teeth 


1 boss 




2 intellect 

3 intelligence 


15 person 


2 thick 


58 brain 


13 face 


2 ph_\'siology 


9 think 


32 brains 


1 father 


1 king 


1 planning 


6 thinking 


1 branch 


1 feature 


1 Pope 


16 thought 


1 bripht 


2 features 


17 knowledge 


3 power 


4 thoughts 


1 brown 


26 feet 


2 president 


1 tired 




1 figure 


19 large 


1 pretty 


31 top 


7 cabbage 


1 firm 


1 leadership 


2 principal 


2 trunk 


3 captain 


2 first 


1 leading 


1 procession 




1 cattle 


1 food 


1 life 




2 useful 


2 cavity 


64 foot 


2 light 


1 quarters 




2 chest 


1 forehead 


3 limb 




1 whirl 


2 chief 


1 front 


1 limbs 


2 rest 


1 wit 


1 chop 




1 little 


21 round 


1 woman 


1 clear 


1 giri 


1 long 


1 roundness 


2 woman's 


2 comb 


1 glasses 


1 louse 


3 ruler 


1 work 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



83 







71. STOVE 






3 article 


1 dinner 


213 heat 


4 lid 


1 round 




1 dirt 


1 heating 


3 lifter 


1 rusty 


1 bake 


1 dishes 


1 heats 


1 light 




1 bakinp 




5 heater 


1 long 


1 shovel 


59 blark 


217 fire 


2 heavy 




1 sink 


4 blacking 


3 fireplace 


1 home 


2 metal 


2 small 


X box 


1 flame 


86 hot 




1 smoke 


1 breakfast 


3 food 


2 house 


1 oil 


3 steel 


2 briRht 


1 Franklin 


1 household 


1 oven 


1 straeture 


12 burn 


1 frv 








2 burning 


1 fuel 


1 icebox 


1 painful 


1 teakettle 




6 furnace 


1 implement 


18 pipe 




1 chair 


8 furniture 


2 instrument 


1 pipes 


1 using 


1 chimney 


1 fumitureness 


51 iron 


5 poker 


2 utensil 


26 coal 




1 isinglass 


10 polish 




2 comfort 


7 gas 






32 warm 


24 cook 


1 German 


4 kettle 


2 radiator 


42 warmth 


34 cooking 


2 good 


11 kitchen 


19 range 


1 water 


1 cooks 


1 grate 




1 receptacle 


2 winter 


3 cover 




3 lamp 


1 red 


7 wood 




2 hard 


2 large 


2 room 




1 dark 


1 hardware 


2 legs 




1 zinc 







72. LONG 






1 age 


1 elongated 


7 


large 


1 reed 


1 stupid 


1 anxiety 


1 endless 


1 


lasting 


3 ribbon 


1 summer 


1 arm 


1 enough 


1 lecture 


1 ride 




1 arms 


2 eternity 


1 legs 


15 river 


3 table 


2 avenue 


1 extended 


50 length 


32 road 


26 tall 


1 away 


1 extension 


6 


lengthy 


1 rod 


1 test 




1 extensive 


1 


level 


1 room 


2 thin 


1 bam 


1 extent 


4 life 


7 rope 


2 thread 


1 beach 




5 


line 


1 row 


1 throw 


1 bench 


8 far 


1 linear 


1 rug 


15 time 


1 big 


1 feet 


1 


live 


2 rule 


1 tiresome 


1 blackboard 


1 fellow 


1 


Lusitania 


4 ruler 


1 tower 


■2 board 


2 fence 








3 track 


6 boat 


1 flagpole 


5 


man 


1 shape 


2 train 


1 book 


1 foot 


7 


measure 


1 sharp 


4 tree 


1 boulevard 


1 for 


2 


medium 


1 shore 


1 trip 


1 bridge 




1 


meter 


413 short 




2 broad 


2 giant 


13 


mile 


1 shovel 


1 vast 


1 Brooklj-n 


1 girl 


1 


miles 


1 slender 


1 very 


Bridge 


2 glass 


1 Mississippi 


1 slim 




1 broomstick 


4 grass 


1 much 


1 slow 


1 wait 


1 building 


1 great 






1 small 


2 waiting 






1 


name 


2 snake 


7 walk 


1 cable 


2 hair 


15 


narrow 


1 something 


1 walking 


1 chimney 


2 hall 


2 


night 


1 space 


1 walls 


1 coat 


1 head 


i 


nose 


1 spacious 


6 way 


1 courage 


1 height 






1 spire 


1 ways 


1 craving 


5 hiffh 


1 


oblong 


1 square 


1 weary 




1 bill 






1 stay 


1 whale 


9 day 


1 hose 


2 


path 


1 steamer 


1 while 


1 days 


1 hours 


1 


person 


1 steeple 


7 wide 


1 deep 


1 house 


1 


pin 


8 stick 


1 winter 


1 depth 




1 


pipe 


1 sticks 


1 wire 


1 desirable 


2 Island 


1 


plant 


2 story 


1 wishing 


1 dimensions 




1 


plenty 


1 straight 


1 without 


SI distance 


8 journey 


20 


pole 


6 street 


1 worm 


3 distant 








1 streets 




6 dress 


1 labor 


4 


railroad 


I strength 


4 yard 


1 duration 


3 lane 


1 


railway 


2 stretch 


2 year 




2 lanky 


1 


rails 


6 string 





84 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



73. RELIGION 



1 Abraham 


2 different 


1 honor 


1 obey 


2 science 


1 aesthetics 


1 difficult 


1 house 


3 opinion 


1 scripture 


1 aim 


1 dislike 


1 h>-pocrisy 


1 order 


3 sect 


1 all 


1 divine 




1 orthodox 


2 sectarian 


1 anything 


4 doctrine 


2 idea 




1 self 


1 association 


1 dogma 


1 ideas 


1 paganism 


3 service 


2 atheism 


2 doubt 


1 ignorance 


3 peace 


1 sheen ey 


4 atheist 


1 Druids 


1 indefinite 


3 people 


1 society 




1 duties 


1 indiscreet 


1 perfect 


1 solace 


2 Baptist 


2 duty 


1 institutions 


1 persecution 


1 somewhat 


1 beauty 




1 irreligion 


2 person 


1 soul 


39 belief 


1 emotion 


1 irreligious 


3 persuasion 


1 spirituality 


1 beliefs 


4 Episcopal 




13 piety 


1 stability 


2 believe 


1 Episcopalian 


3 Jesus 


13 pious 


1 standby 


1 believing' 


1 eternity 


3 Jew 


2 poor 


1 study 


1 believer 


2 ethics 


1 Jews 


1 Pope 


1 superstition 


1 belong 


1 everyday 


4 Jewish 


1 powerful 




1 belonging 




1 just 


2 practice 


1 tabernacle 


52 Bible 


1 fair 




2 pray 


1 table 


1 body 


47 faith 


2 kind 


2 praying 


1 teaching 


2 books 


1 fake 


1 knowledge 


21 prayer 


1 temperament 


3 brain 


2 fanatic 




5 prayers 


2 temple 


1 Buddha 


1 fanaticism 


1 law 


2 prayer-book 


2 think 




1 feeling 


1 learning 


2 preacher 


1 thinking 


1 catechism 


1 fine 


4 life 


2 preaching 


12 thought 


56 Catholic 


2 foolish 


1 living 


3 Presbyterian 


1 thoughtful 


2 ceremony 


1 free 


1 Lord 


28 priest 


1 training 


1 China 




1 Lutheran 


3 profession 


1 true 


8 Christ 


1 gentile 




1 professor 


1 trust 


14 Christian 


1 German 


1 man 


30 Protestant 


6 truth 


7 Christianity 


31 God 


1 men 


1 pulpit 




1 Christlike 


1 godly 


1 mankind 


2 pure 


1 uncertain 


161 church 


46 good 


1 many 


1 puzzle 


1 uncertainty 


4 churches 


10 goodness 


1 mental 




1 unknowable 


1 churchman 


2 gospel 


1 Methodism 


1 question 




1 civilize 


1 government 


7 Methodist 




1 virtuous 


1 clergyman 


3 guide 


In minister 


1 race 


1 vow 


4 comfort 




1 modesty 


1 rector 




1 commandments 


3 happiness 


2 Mohammed 


2 religious 


1 want 


1 conduct 


1 harmonv 


2 morals 


3 reverence 


1 wickedness 


1 Congregational 


1 health ' 


1 mystic 


2 right 


1 wide 


2 conscience 


3 heathen 




2 righteousness 


1 woman 


1 conversion 


8 heaven 


2 nationality 




1 wonder 


2 Creator 


1 Hebrew 


1 need 


1 sacrament 


1 wonderful 


33 creed 


2 helpful 


1 no 


4 sacred 


1 work 


1 custom 


1 hereafter 


5 none 


1 sacredness 


14 worship 




1 heresy 


2 nothing 


1 saintly 


1 worshipping 


1 deep 


2 history 


1 nun 


1 saints 




11 denomination 


4 holiness 


1 nuns 


2 salvation 


1 Yankee 


4 devotion 


10 holv 




1 scholastic 





74. WHISKEY 



1 abomination 


24 brand V 


1 deviltry 


2 evil 


2 hot 


50 alcohol 


1 breath 


1 Dewar's 




1 hotels 


1 ale 


1 bum 


1 disagreeable 


1 fast 


1 Hunter 


1 amber 


4 burning 


1 discontent 


4 fire 




1 appetizer 




1 disgust 


1 flask 


1 indulge 


1 apple 


1 Carrie Nation 


1 distillery 


4 fluid 


1 indulgence 


1 awful 


3 cider 


1 distress 


1 food 


1 inebriety 




1 closet 


1 dope 


1 full 


1 insanity 


35 bad 


1 color 


1 dreadful 




5 intemperance 


1 barley 


1 com 


232 drink 


8 gin 


13 intoxicant 


2 barrel 


4 curse 


1 drinks 


3 glass 


2 intoxicants 


1 bod 




17 drinking 


15 good 


3 intoxicated 


46 benr 


1 dangerous 


1 drinkable 


1 grain 


U intoxicating 


beverage 


1 dark 


1 drug 




14 intoxication 


1 biting 


1 death 


31 drunk 


1 hard 




5 bitter 


1 degradation 


18 drunkard 


1 headache 


1 jag 


10 booze 


1 despised 


3 dnmkards 


1 Hennesspy's 




1 Boston 


1 destmction 


26 drunkenness 


1 hops 


1 Kentucky 


29 bottle 


1 devil 




1 horror 


1 knock 



I9IOJ 



GRACE HELEN KENT AND A. J. ROSANOFF 



85 



1 law 


1 odor 


1 ruin 


5 spirit 


1 terrible 


12 liquid 


1 old 


1 ruination 


23 spirits 


1 thirst 


1 liquids 




23 mm 


38 stimulant 


1 thirsty 


70 liquor 


1 pint 


9 rye 


4 stimulants 


1 tipsy 




1 place 




1 stimulating 


1 toddy 


2 malt 


1 pleasant 


15 saloon 


1 stimulation 


1 toper 


2 man 


4 poison 


1 saloons 


1 stomach 


2 trouble 


4 medicine 


1 poor 


1 Scotch 


2 straight 




1 misery 


1 poorhouse 


1 seasickness 


6 strong 


1 unhealthy 


1 money 


1 powerful 


2 sick 


1 stupidity 


1 unpleasantness 


1 moonshine 


2 prohibition 


2 sickness 


1 suffering 






1 punch 


2 smell 




1 warm 


3 narcotic 




1 smuggle 


1 taste 


9 water 


2 nice 


1 rarely 


1 sorrow 


4 temperance 


16 wine 


1 none 


2 red 


4 sour 
75. CHILD 


1 temptation 


1 wrong 


5 adult 


1 darling 


1 hair 


8 love 


1 precocious 


3 angel 


2 daughter 


2 happiness 


2 loving 


10 pretty 




1 dear 


2 happy 


4 lovely 


1 pupil 


7 babe 


1 dearest 


1 healthy 




1 pure 


[93 baby 


1 delight 


1 helpless 


1 male 


1 purit}' 


1 bad 


1 disobedient 


1 helplessness 


1 mammal 




8 beautiful 


1 dog 


6 home 


41 man 


1 rattle 


5 beauty 


4 doll 


2 hood 


1 maternity 


1 religious 


S being 


4 dress 


1 hospital 


1 me 




2 birth 


1 dresses 


5 human 


1 mite 


5 school 


2 blessing 




1 humanity 


55 mother 


1 screaming 


2 body 


1 Eleanor 




1 motherhood 


1 senses 


1 born 


1 Elizabeth 


1 ill 




1 simple 


64 boy 


1 embryonic 


1 immature 


1 naive 


1 simplicity 


3 boys 


1 expectation 


1 infancy 


1 naughty 


1 sister 


1 burden 




122 infant 


1 necessary 


52 small 




2 family 


1 injury 


1 nephew 


1 smile 


1 care 


1 fat 


16 innocence 


1 nice 


2 son 


1 carriage 


5 father 


11 innocent 


1 night-dress 


1 spoiled 


1 charm 


3 female 


1 instinct 


1 noise 


1 study 


1 childhood 


1 frolicsome 


2 interesting 


2 nuisance 


6 sweet 


1 childish 


2 fun 






2 sweetness 


J Christ 


1 fussy 


1 joy 


1 obedient 




1 clothes 


I future 


2 juvenile 


6 offspring 


1 table 


3 comfort 








1 tender 


1 coming 


45 girl 


4 kid 


6 parent 


1 three 


1 companion 


2 girls 


1 kindergarten 


1 parents 


1 toys 


2 cradle 


1 glass 




3 people 


1 trouble 


1 creep 


T good 


2 labor 


IS person 


3 weak 


1 crib 


1 goose 


2 lady 


1 pet 


18 woman 


1 cries 


1 Greta 


2 large 


14 play 




4 cry 


1 growing 


1 like 


3 playing 


30 young 


1 cross 


1 growth 


11 little 


3 playful 


2 youngster 


1 cunning 




1 lonely 


4 pleasure 


29 youth 


3 cute 


1 habits 


1 lovable 
76. BITTER 


1 plump 


1 youthful 


8 acid 


5 beer 


1 disappointment 


1 grudge 


1 limes 


1 acrid 


I berry 


2 dislike 




1 liquor 


1 agreeable 


1 biting 


10 distasteful 


2 hatred 


1 love 


1 ale 


1 boneset 


1 dregs 


2 herb 




4 almond 


1 burdock 


2 drink 


5 herbs 


1 magen 


3 almonds 






1 hops 


1 man 


4 aloe 


1 candy 


2 enemy 


3 horrid 


1 mandrake 


6 aloes 


1 cascara 




1 horseradish 


37 medicine 


1 altogether 


1 chastisement 


1 feelings 




1 Mirabar 


2 alum 


1 chickory 


1 flag 


1 icy 


1 morphine 


3 anger 


1 chocolate 


4 fruit 


1 ill 


3 nastj' 
1 nice 


3 apple 


1 cider 




1 irritating 


1 apples 


6 cold 


42 gall 






1 apricot 


1 cross 


2 good 


S lemon 


, 


1 astringent 


1 cup 


1 grape 


1 lemons 


■ 






3 grapefruit 


1 lemonade 


1 offensive 


10 bad 


1 deep 


1 grass 


1 lessons 


1 olives 


1 banana 


10 disagreeable 


2 grief 


1 life 


3 orange 



86 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



1 peach 

1 peel 

9 pepper 

2 persimmon 

3 pickle 
1 pickles 
1 pleasant 

4 plums 
1 poison 
3 pucker 

i puckering 

1 quassia 



1 quince 
23 quinine 

1 rank 

1 sadness 

2 salt 

2 salts 

3 sharp 
8 sorrow 

1 sound 
222 sour 

2 Boumess 



1 spice 

3 strong 

1 strychnia 

4 strychnine 
1 suffering 

305 sweet 
1 sweeter 

8 tart 
66 taste 
3 tasteless 
1 tasting 
1 tea 



1 tears 

1 temper 

3 thoroughwort 

1 thought 

1 tonic 

2 tonics 
1 trouble 
1 turnip 

3 ugly 

1 unhealthy 
1 unpalatable 
19 unpleasant 



1 unpleasantness 
1 unsweetened 
1 unwholesome 

1 vegetables 
17 vinegar 

1 water 
1 weather 
1 wine 

1 word 

2 words 

2 wormwood 
1 wrong 



77. HAMMER 



2 action 


5 driving 


1 knife 


1 plumber 


4 striking 


1 annoyance 


1 door 


35 knock 


51 pound 


1 stroke 


6 anvil 




6 knocker 


12 pounding 




1 article 


1 easy 


5 knocking 


1 pounds 


3 tack 


1 awl 


1 effort 






11 tacks 


11 axe 




2 large 


1 rap 


1 Thor 




3 finger 


1 lost 


1 repairs 


1 thread 


3 bang 


2 force 




1 revolver 


6 throw 


1 beating 




3 mallet 


1 road 


1 throwing 


2 blacksmith 


1 geology 


1 mark 


1 rod 


1 thumb 


6 blow 




1 maul 


1 round 


1 thump 


2 board 


5 handle 


1 metal 




1 toe 


1 bruiser 


53 hard 




saw 


29 tongs 


2 building 


6 hatchet 


185 nail 


1 scissors 


69 tool 




2 head 


93 nails 


1 shoemaker 


3 tools 


13 carpenter 


13 heavv 


2 nailing 


1 shop 


1 turf 


1 carpentering 


21 hit 


36 noise 


m sledge 




10 chisel 


1 horseshoe 


1 nut 


2 small 


1 use 


1 claps 


1 hurt 


1 nuts 


sound 


5 useful 


1 claw 


1 hurts 




1 spade 


1 utensil 


2 club 




2 one 


1 stav 




1 concussion 


8 implement 




20 steel 


3 weapon 


1 convenience 


38 instrument 


1 pain 


1 stone 


3 weight 




45 iron 


2 picture 


1 strength 


6 wood 


17 drive 




1 pictures 


28 strike 


8 work 


1 drives 


2 J. 






2 working 



7S. THIRSTY 



1 all 


1 desiring 


1 glass 


1 nauseated 


1 suffering 


2 always 


1 dipper 


1 good 






1 animal 


1 disagreeable 




1 oranges 


1 terrible 


3 appetite 


2 discomfort 


1 hard 




1 throat 




2 doff 


1 haste 


2 pain 


1 tongue 


1 bar 


2n6 drink 


2 heat 


3 parched 




4 beer 


23 drinking 


1 horse 


2 parching 


1 uncomfortable 


1 beverage 


8 dronght 


2 hot 


1 people 


2 unpleasant 


1 bird 


218 dry 


9 hunger 


1 person 




1 boy 


5 dryness 


41 hungry 




1 verv 


1 brooks 






12 quench 


1 vichy 




1 emotion 


1 labor 


4 quenched 




1 cattle 


1 empty 


2 lack 




2 walk 


2 child 


1 exhausted 


1 lawn 


1 refreshing 


want 


1 cold 




7 lemonade 




2 wanting 


4 craving 


1 famished 


1 liquid 


1 satiated 


1 warm 


1 cream 


1 fatiinie 


4 longing 


3 satisfied 


341 water 


2 cup 


5 feeling 




1 sensation 


1 wench 




1 fluid 


1 man 


2 snda 


3 wet 


2 despft 


1 fnod 


2 mouth 


3 spring 


2 work 


4 desire 


1 fountain 




1 stream 





igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



87 







79. CITY 






1 Albany 


1 Creal 


3 house 


1 mill 


1 sights 




1 Creal Springs 


52 houses 


1 mountain 


1 sin 


1 beautiful 


11 crowd 




1 municipal 


1 size 


9 biff 


7 crowded 


1 immense 


1 municipality 


1 slums 


5 Boston 


1 crowds 


1 incorporated 




1 small 


1 bridges 




1 incorporation 


1 nation 


1 smoke 


3 Brooklyn 


1 density 


2 industry 


99 New York 


2 space 


6 building 


1 dirt 


1 inhabitant 


12 noise 


1 Springfield 


20 buildings 


1 distance 


12 inhabitants 


tt noisy 


26 state 


1 bulk 




1 inhabited 




1 stores 


1 Burlington 


1 earth 




1 park 


3 street 


1 business 


1 excitement 


1 joy 


1 pavement 


11 streets 


4 busy 






48 people 




2 bustle 


1 fine 


2 land 


37 place 


1 tale 




1 fun 


62 large 


1 pleasantness 


1 ten thousand 


6 capital 




1 largeness 


2 populated 


2 theatre 


3 cars 


1 gaiety 


2 life 


l!) population 


1 theatres 


1 charming 


1 good 


7 live 


1 populous 


2 towers 


4 Chicago 


1 government 


1 loathing 


6 Poughkeepsie 


25S town 


1 child 


1 governor 


2 location 




1 towns 


7 citizen 


2 great 


1 lots 


2 republic 


1 township 


1 civilization 


1 greatness 




2 residence 


1 traffic 


1 Cleveland 




1 machinery 


1 resting 


1 traveling 


2 collection 


3 habitation 


1 majority 


1 rich 


1 tumult 


5 community 


1 heat 


1 Manhattan 


1 scene 


2 turmoil 


1 complexity 


2 hill 


2 manufacture 


1 sea 


44 village 


1 confusion 


5 home 


3 many 


1 settlement 


1 congregation 


1 homes 


2 men 


1 shopping 


1 wagons 


2 corporation 


1 hot 


6 metropolis 


1 shops 


1 welcome 


74 country 




80. SQUARE 




1 world 


1 accurate 


1 crackers 


3 green 


1 measurements 


2 sharp 


1 acre 


3 crooked 


1 grounds 


1 metal 


1 side 


1 across 


1 crowd 




2 mile 


6 sides 


1 active 


9 cube 


1 hand 


1 monument 


1 sidewalk 


1 airy 


1 cubic 


2 handkerchief 




1 8i2e 


11 angle 


1 cubical 


1 Harlem 


1 New York 


1 sizing 


6. angles 


1 curse 


2 Herald 




6 small 


4 angular 


1 curve 


1 hea^'y 


2 object 


1 smooth 


a arithmetic 




3 honest 


32 oblong 


2 solid 


1 association 


1 deal 


1 honesty 


1 obtuse 


1 space 




1 dealing 


5 house 


1 open 


2 stand 


1 bed 


1 decoration 


3 houses 


5 oval 


1 steel 


1 best 


2 desk 






7 straight 


1 big 


1 Dewey 


2 inch 


5 paper 


9 street 


71 block 


4 dice 


1 inches 


1 parallel 


1 streets 


4 board 


1 die 


1 instrument 


1 parallelogram 


1 sugar 


4 book 


2 door 


1 iron 


14 park 


1 surface 


36 box 


1 DUsseldorf 


1 just 


1 pavements 


1 surveyor 


2 brick 




2 people 




5 broad 


1 earth 


2 justice 


2 perfect 


47 table 


2 building 


1 ease 


1 junction 


1 picture 


1 thoroughfare 


1 businesa 


6 equal 


1 kindergarten 


2 pillow 


3 Times 




19 even 


1 knob 


4 place 


13 tool 


9 carpenter 


1 evenness 




1 plane 


1 tree 


1 carpet 


1 exact 


2 land 


1 plot 


4 trees 


1 cars 




5 large 


1 proportion 


11 triangle 


2 center 


3 fair 


1 Lawrence 


2 public 


1 true 


1 Chatham 


4 fipld 


2 length 






1 checkers 


4 figure 


10 level 


1 quadrangle 


1 uneven 


22 circle 


1 file 


2 lines 


15 rectangle 
3 rectangular 
1 rhomboid 


1 uniform 


1 circular 
4 city 


4 flat 
1 floor 


1 little 
18 long 


4 Union 
2 upright 


1 Common 
1 Commons 
fi compass 


2 foot 

1 form 

10 four 


1 lot 
12 Madison 


5 right 

1 Rittenhouse 

1 road 


8 village 
1 walk 


I concert 
1 Copley 


1 frame 
1 furlong 


f> man 
1 mark 


5 room 
250 round 


1 walks 
1 wall 


7 comer 




1 marks 


9 rule 


4 Washington 


18 corners 


5 garden 


1 masonry 


3 ruler 


2 wide 


2 cornered 


10 geometry 


2 mathematics 




1 witiHaw 


1 correct 


1 Getty 


1 meal 


1 saddle 


-I. »*ill\J\J\* 

5 wood 


1 correctness 


1 goods 


5 measure 


1 seat 


1 cover 


1 grass 


2 measurement 


6 shape 


2 yard 



88 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



81. BUTTER 



2 bad 


5 dish 


2 goat 


101 milk 


1 smooth 


2 bill 


1 dripping 


14 good 


1 molasses 


65 soft 


2 biscuit 




76 grease 


1 mush 


2 softness 


200 bread 


34 eat 


6 greasy 




1 sour 


1 breakfast 


12 eatable 


1 grocer 


1 nourishment 


1 spoon 


1 butter 


2 eatables 




2 nut 


3 spread 


1 butterine 


6 eating 


1 healthful 




1 square 




1 edible 




9 oil 


, 2 strong 


41 cheeso 


2 egg 


1 indiiTerence 


3 oily 


1 substance 


4 churn 


11 eggs 


1 ingredients 


5 oleomargarine 


4 sugar 


1 color 


1 emollient 






1 supper 


1 composition 


1 excellent 


3 jam 


1 peaches 


12 sweet 


1 cooking: 




2 jelly 


3 plate 




1 cottolene 


1 farm 




1 pleasant 


2 table 


1 country 


1 farmer 


1 kerosene 


1 plenty 


1 tallow 


1 cup 


21 fat 


7 knife 


1 pound 


2 taste 


29 cow 


1 fatty 




1 pure 


2 tea 


11 cows 


Iflah 


15 lard 




1 thin 


34 cream 


1 flour 
7 fly 


1 luxury 


2 rancid 


1 tub 


4 dairy 


63 food 


1 meal 


13 salt 


1 use 


1 dairying 


3 fresh 


2 meat 


3 salty 


3 vegetable 


2 diet 


1 fudge 


1 melt 


1 salve 


2 dinner 




2 melting 


1 smear 


80 yellow _ 



82. DOCTOR 



1 administer 


5 disease 


5 ill 


1 murder 


1 quack 


3 aid 


1 diseases 


21 illness 






1 ailment 


1 Divinity 


2 inquisitive 


IN. 


6 relief 


1 apparatus 


1 doctress 


2 intelligent 


1 N. 


1 relieved 


2 attendant 


1 dog 


1 interne 


2 necessity 


1 remedy 




1 driving 


1 invalid 


1 need 




1 bad 


1 Dr. P. 




1 needed 


IS. 


1 bag 


2 druggist 


1 K. 


1 needful 


3 satchel 


2 beard 




1 K. 


1 nice 


2 science 


2 better 


2 education 


1 killer 


41 nurse 


1 scientist 


3 bill 




1 kind 


1 nurses 


52 sick 


2 bills 


2 fakir 






104 sickness 


1 bottle 


3 false 


1 labor 


1 0. 


3 smart 


1 brains 


2 father 


1 laboratory 


1 oflJce 


1 student 


1 brother 


3 friend 


1 laborer 


1 old 


1 suffering 


1 butcher 




1 lamp 


1 one 


1 supervisor 




1 G. 


36 lawyer 


1 operation 


6 surgeon 


1 C. 


1 G. 


1 learned 




1 surgical 


1 C. 


1 gentleman 


1 life 


1 P. 


1 syringe 


2 care 


17 good 




2 pain 




2 carriage 


1 goodness 


IM. 


1 papa 


1 tend 


1 case 


1 great 


1 McC. 


23 patient 


1 treatment 


1 chief 


2 grip 


1 McM. 


1 patients 


3 trouble 


1 clergyman 




1 magistrate 


1 people 


1 trust 


1 clever 


5 healer 


1 male 


3 person 




1 college 


2 healing 


68 man 


1 pharmacist 


2 useful 


1 convenient 


18 health 


1 mean 


1 physical 


1 useless 


9 cure 


3 help 


19 medical 


213 phvsician 






1 helper 


149 medicine 


1 pills 


1 W. 


1 D. 


1 helpful 


1 medicines 


2 practitioner 


1 W. 


1 D. 


1 helpfulness 


1 merchant 


6 priest 


1 w. 


1 D. 


1 home 


7 minister 


9 profession 


1 well 


1 death 


8 hospital 


1 mister 


3 professional 


1 wise 


6 dentist 




1 money 




2 woman 
1 work 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



89 



83. LOCD 



3 angry 


3 disagreeable 


2 laugh 


1 power 


2 sounds 


1 audible 


1 discontent 


2 laughing 




3 speak 




1 dislike 


2 laughter 


32 quiet 


2 speech 


Iband 


3 drum 


1 lofty 


1 quietness 


2 spoken 


1 bawl 




3 long 




7 still 


5 bell 


3 ear 


57 low 


1 racket 


1 stone 


2 bells 


12 easy 




1 real 


8 strong 


2 birds 


4 explosion 


1 man 


1 report 


1 subway 


38 boisterous 




1 masculine 


2 rough 


1 sweet 


1 boy 


3 fast 


1 megaphone 


2 rude 




2 boys 


1 forte 


1 mellow 




12 talk 


1 bright 




1 mild 


1 S. 


1 talking 




1 game 


1 mouth 


9 scream 


9 talker 


2 call 


1 gong 


7 music 


2 sharp 


9 thunder 


1 called 


1 graphophone 




1 shock 


1 tie 


1 calliope 


2 gun 


205 noise 


6 shout 


1 tone 


1 calm 


1 guns 


112 noisy 


1 shouting 


1 trolley 


12 cannon 






1 shriek 




1 check 


2 hammer 


1 objectionable 


9 shrill 


1 uncomfortable 


1 child 


2 hard 

3 harsh 


1 ocean 


1 shrinking 


5 unpleasant 


1 children 


1 organ 


3 silent 




1 city 


1 haughty 


1 owl 


1 sing 


27 voice 


1 clear 


6 hear 
1 heard 
4 heavy 




1 singer 


1 voices 


2 course 


1 pain 


1 singing 


4 vulgar 


2 color 


1 painful 


4 slow 




1 common 


14 high 


1 people 


1 smart 


2 whisper 


1 confusion 


1 hog 


2 person 


1 smooth 


17 whistle 


1 cornet 


16 holler 


1 phonograph 


1 socks 


1 wide 




4 bom 


2 piano 


16.5 soft 


3 wind 


1 deaf 


1 impatient 


1 piercing 


1 softly 




1 deafening 


1 pistol 


2 song 


3 yell 


1 din 


2 knock 


1 pistols 
84, THIEF 


25 sound 


2 yelling 


1 absence 


1 dishonor 


1 laugh 


1 porketbook 


212 steal 


1 abstractor 


1 dislike 


4 law 


8 police 


69 stealing 


1 anffcr 


1 distrustful 


1 lawyer 


12 policeman 


S steals 


1 arrest 


1 dirt 


6 liar 


1 poor 


stole 




1 dog 


1 lock 


6 prison 


9 stolen 


14 bad 


1 dumb 


3 loss 


1 prisons 


2 stealer 


1 badness 




2 low 


T prisoner 


1 stealth 


1 bandit 


1 enemy 




2 punishment 


2 stealthy 


1 bank 


1 evil 


2f) man 


1 purse 




3 beggar 




1 mask 




5 take 


1 being 


2 fear 


1 McCIure's 


1 ran 


3 taking 


1 betrayer 


1 felon 


4 mean 


4 rascal 


1 time 


3 boy 




1 meanness 


1 reverses 


2 tools 


118 burglar 


1 girl 


1 men 


1 revolver 


1 tramp 


2 burglary 


1 glove 


1 mercenary 


8 rob 


1 treasure 




2 gold 


2 merchant 


126 robber 


1 troublesome 


2 careful 


1 good 


2 minister 


10 robbery 


1 trust 


2 catch 




1 mischief 


19 rogue 




4 caught 


1 harsh 


1 misdemeanor 


1 roguish 


3 ugly 


1 caution 


18 honest 


1 mistake 


1 run 


1 undesirable 


1 chief 


4 honesty 


16 money 


2 running 


1 unjust 


1 clerk 


4 house 


5 murder 




1 unreliable 


1 clothing 


1 household 


3 murderer 


1 scare 




4 court 






1 schemer 


1 vagrant 


2 crime 


1 ignorant 


1 necessity 


1 school 


2 valuables 


C^ 15 criminal 


1 injustice 


1 neighbor 


4 scoundrel 


2 lice 


3 crook 


1 interest 


1 newspaper 


1 shot 


5 villain 


T cry 


1 Irish 


16 night 


4 silver 


1 virtue 


2 culprit 




1 none 


1 silverware 




1 cute 


11 jail 


1 noted 


1 sin 


1 want 




7 jewelry 




1 Sing Sing 


3 watch 


2 dangerous 


3 jewels 


1 object 


1 sinner 


1 wa^-wardness 


4 dark 


1 udge 




1 sly 


4 wicked 


1 deceit 


1 jury 


1 pencil 


1 snake 


3 wickedness 


1 detective 


2 justice 


1 person 


7 sneak 


1 window 


1 devil 




2 pickpocket 


3 sneaking 


1 woman 


11 dishonest 


1 killed 


1 play 


1 sneaky 


1 WTctched 


2 dishonesty 


1 kleptomaniac 


1 pocket 


1 spoils 


3 wrong 



90 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







85. I.ION 






4 Africa 


5 cub 


1 hearted 


27 mouse 


1 story 


1 Androclea 


2 cubs 


1 holler 


1 mule 


30 strength 


1 anger 




1 horse 




15 strong 


2 anffry 


S danger 


1 howl 


1 N. 


1 Sultan 


326 aninial 


6 dangerous 


1 huge 


1 noble 




3 animals 


1 death 


1 hungry 


1 noise 


4 tame 




13 den 


3 hunter 




1 tamer 


17 bear 


3 desert 


4 hunting 


1 panther 


1 tail 


67 beast 


1 devours 


1 hyena 


2 park 


1 teeth 


1 beautiful 


1 disturber 




1 paw 


1 terrible 


1 beauty 


1 dog 


1 interested 


1 picture 


102 tiger 


2 biff 






5 power 


2 tigers 


1 bird 


1 eat 


1 jealous 


1 powerful 




1 bite 


1 eats 


6 jungle 


1 prey 


7 ugly 


1 blood 


3 elephant 


1 jungles 






1 boisterous 


1 enraged 




1 rage 


5 vicious 


2 bold 




16 king 


1 raging 




1 Bostofk's 


3 fear 




1 revenge 


1 walks 


4 brave 


16 ferocious 


1 L. 


48 roar 


2 wicked 


1 bravery 


1 ferocity 


6 lamb 


3 roars 


12 wild 


1 Bronx 


36 fierce 


3 large 


6 roaring 


1 wildness 




1 fierceness 


10 lioness 


S Roosevelt 


2 wilderness 


14 cage 


6 forest 


1 lionized 


1 rough 


1 wilds 


1 camel 


1 fox 


1 lookout 




10 wolf 


6 cat 


1 fright 




1 savage 


2 woods 


1 cave 


1 frightened 


1 majestic 


1 sea 


1 wool 


1 Christian 




3 majesty 


1 shaggy 


1 wrath 


2 circus 


1 giraffe 


13 mane 


1 sharp 




2 claws 


2 great 


5 menagerie 


1 sheep 


1 yellow 


1 cow 


1 growl 


1 mice 


1 small 




1 crouching 




1 mighty 


1 stealth 


5 zoo 


2 cruel 


3 hair 


1 monkey 
86. JOY 


1 stealthy 


1 zoology 


1 action 


2 delighted 


7 great 


1 merriment 


1 sensation 


1 amuse 


2 delightful 


18 grief 


1 merry 


1 shouting 


3 amusement 


1 despair 




7 mirth 


2 show 


1 anger 




1 hands 


1 money 


1 sing 


1 angry 


1 erstasv 


215 happiness 


1 motherhood 


1 singing 


1 anticipation 


3 elated 


71 happy 


2 much 


2 smile 


1 arrival 


1 emotion 


1 harmony 


5 music 


1 smiling 


4 automobile 


1 engaged 


1 health 




3 song 




2 enjo^Tnent 


1 heard 


1 news 


135 sorrow 


1 ball 


3 excitement 


3 heart 


2 nice 


1 sorrv 


1 bird 


2 expression 


2 heaven 


1 noise 


1 state 


1 birth 


1 extreme 


1 holiday 




1 suffering 


1 birthday 


1 exuberance 


6 home 


1 outing 


1 summer 


1 bitterness 




4 hope 




1 sunlight 


1 bless 


1 fair 




1 pain 


6 surprise 


1 blessing 


1 familv 


1 inexpressible 


1 passing 


4 sweet 


10 bliss 


1 feel 




23 peace 


1 sweetness 


1 bov 


5 feeling 


1 joking 


1 picnic 




1 bright 


1 felt 


1 jubilant 


1 picnics 


2 time 


1 brightueso 


1 festivity 




S pleasant 


1 triumph 


1 buoyant 


2 fine 


1 lady 


3 pleased 


3 trouble 




1 food 


7 laugh 


121 pleasure 




1 cheer 


1 forever 


4 laughing 


1 pride 


1 unalloyed 


2 cheerful 


1 friends 


15 laughter 




1 unattainable 


3 cheerfulness 


1 fullness 


1 leap 


1 quality 


2 unhappiness 


2 child 


6 fun 


1 letters 




1 unhappy 


1 children 




3 life 


4 rapture 




2 Christmas 


1 gaiety 


2 light 


2 rejoice 


1 vacatioii 


1 comes 


1 pay 


1 like 


1 rejoicing 




11 comfort 


1 g.-ime 


2 line 


2 relief 


1 water 


1 comfortable 


1 gift 


1 lonely 


7 ride 


1 wedding 


1 company 


2 girl 


1 lots 


2 riding 


1 wetness 


1 complete 


1 girls 


6 love 


1 rider 


1 wish 


1 concert 


27 glad 


2 loving 




1 wonderful 


1 contentment 


44 gladness 


1 lovely 


1 sad 


2 work 




3 glee 




13 sadness 


1 wrath 


3 dance 


1 godliness 


1 man 


2 sailing 




5 dancing 


7 good 


2 marriage 


1 Saturday 


1 youth 


6 delight 


1 grand 


2 meeting 


1 seldom 





igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



91 







87. BED 






1 animal 


1 covering 


2 house 


17 pillow 


3 sleepiness 


1 asleep 






7 pillows 


7 sleepy 




1 desired 


9 iron 


1 pleasure 


3 slumber 


1 baby 


1 dormitory 


1 joy 


3 post 


7 sofa 


3 bedding 


1 down 




31 soft 


4 bedstead 


1 dreamland 


2 large 


1 quilts 


5 spread 


4 blanket 




8 lay 




1 spring 


3 blankets 


1 ease 


1 laziness 


1 recline 


1 springs 


1 boat 


1 easiness 


21 lie 


1 recuperation 


1 square 


1 bowl 


2 easy 


6 lounge 


1 refreshing 


1 stove 


3 brass 




2 low 


9 repose 


1 structure 


2 bug 


1 fatigue 


8 King 


1 respite 


2 table 




3 feathers 




132 rest 


11 chair 


1 flannels 


1 make 


5 resting 


1 tick 


2 clejin 


1 floor 


1 marriage 


1 restful 


1 time 


1 cleanliness 


2 folding 


21 mattress 


1 robe 


7 tired 
1 twilight 


12 clothes 


1 frame 




16 room 


2 clothing 


26 furniture 


1 narrow 




1 Vassar 


35 comfort 




1 negro 


1 seat 




1 comforts 


1 go 


11 night 


6 sheet 


1 want 


12 comfortable 


7 good 




7 sheets 


1 warm 


11 cot 




1 object 


1 shoes 


1 weariness 


26 couch 


2 hammock 




2 sick 


2 white 


1 counterpane 


5 hard 


1 pan 


5 sickness 


1 whiteness 


4 cover 


1 head 


3 patient 


345 sleep 


1 wide 


4 covers 


2 home 


1 peace 


41 sleeping 


4 wood 







88. HEAVY 






1 air 


1 cloudy 


1 heart 


1 oppression 


17 stone 


1 anirnal 


4 coal 


2 hearted 


1 oppressive 


2 stones 


1 anvil 


1 coarse 


1 heft 




2 stout 


1 article 


1 coat 


1 help 


1 package 


3 stove 


1 automobile 


1 comfort 


2 horse 


1 pail 


1 strain 


1 avoirdupois 


1 cumbersome 


1 house 


1 person 
1 piano 


4 strength 
3 strong 


1 babv 


1 dark 


70 iron 


2 ponderous 


1 study 


1 bad 


1 difficult 


2 irons 


1 pound 


1 suit 


1 bat 


1 dirt 




1 pounds 




■2 bed 


1 disappointment 


1 labor 


2 pressure 


5 table 


3 big 


1 discomfort 


2 laden 




3 thick 


1 body 


1 dope 


18 large 


1 quicksilver 


1 things 


3 books 


1 drag 


60 lead 


2 quiet 


1 thoughtful 


1 boulders 


1 drill 


7 lift 




21 tired 


1 box 


1 drowsiness 


1 lifting 


2 rock 


2 tiresome 


1 boxes 


10 drowsy 


273 light 


1 rough 


4 ton 


1 boy 


3 dull 


1 lightness 




1 tough 


1 bread 




67 load 


2 safe 


3 trunk 


1 brick 


1 effort 


1 loadsome 


1 sand 




1 building 


3 elephant 


1 loud 


1 satchel 


1 uncomfortable 


1 bullet 






1 scales 


1 underwear 


4 bundle 


1 F. 


1 machine 


1 sharp 




12 burden 


1 fall 


4 man 


1 ship 


1 very 


3 burdensome 


1 feel 


1 marble 


1 short 






1 firmness 


1 mountain 


1 sickness 


1 weak 


1 cake 


1 full 


I much 


3 sleep 


3 weariness 


1 cannon 




1 mud 


1 sleeping 


3 weary 


1 carpet 


3 gold 


1 muscle 


1 slothful 


1 weather 


2 carry 


1 gorgeous 


1 myself 


1 slumber 


1 weigh 


1 carrying 


1 grief 




5 soft 


1 weighing 


1 cement 


2 grip 


1 no 


1 soggy 


177 weight 


1 chair 






3 solid 


1 weighted 


1 change 


3 hammer 


1 obliging 


1 sound 


22 weighty 


1 cloth 


38 hard 


1 opposing 


1 steel 


4 wood 


1 clothes 


2 head 






2 work 



92 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







80. TOBACCO 






1 amber 


1 elevate 


1 Indian 


69 pipe 


7 strong 


I anger 


1 enjoyed 


3 injurious 


3 pipes 


1 substance 




1 enjoyment 


1 intoxicate 


38 plant 


1 suffocation 


10 bad 


1 execrable 




1 plants 


2 sugar 


1 bite 


1 exhilaration 


7 juice 


3 pleasant 


2 sweet 


4 bitter 


1 evil 




2 pleasure 




1 Bob 




17 leaf 


6 poison 


1 tasty 


1 breath 


1 field 


2 leaves 


1 poor 


1 tobacco 


7 brown 


1 fields 


1 light 


2 pouch 






4 filth 


1 liquor 


1 plug 


1 unclean 


28 chew 


1 filthiness 


1 lungs 




2 unnecessary 


13 chewing 


1 filthy 


2 luxury 


1 refrain 


2 unpleasant 


19 ciffar 


1 food 




1 ruin 


1 unwholesom 


17 oiRars 




3 man 




2 use 


12 cigarette 


1 garden 


1 men 


1 scent 


1 used 


6 cigarettes 


5 good 




1 sensation 


1 useful 


2 comfort 


3 green 


10 narcotic 


1 sin 


2 useless 


1 curse 


1 grower 


2 nasty 


5 smell 






1 growing 


1 nausea 


387 smoke 


3 vegetable 


1 death 




18 nicotine 


98 smoking 


1 vice 


1 decay 


12 habit 


1 none 


1 smoker 


2 Virginia 


1 deviltry 


1 habits 


1 not 


15 snuff 


44 weed 
1 weeds 
1 whiff 
1 whiskey 
1 wickedness 


6 dirty 


1 hard 


1 nuisance 


1 solace 


3 disagreeable 


3 herb 




4 spit 


1 disgust 


1 herbs 


1 obnoxious 


1 stalk 


1 disgusting 


1 horrid 


3 odnr 


1 stars 


3 drug 


1 horrors 


1 odorous 


2 stimulant 


1 Durham 




4 opium 
90. BABY 


1 stimulants 


1 yellow 


1 animal 


2 cross 


1 happiness 


1 milk 


4 sleep 




3 cries 


1 happy 


41 mother 


1 slight 


5 beautiful 


37 cry 


1 harmless 




42 small 


2 beauty 


29 crying 


1 helpless 


1 name 


1 smallest 


1 beginning 


3 cunning 


4 helplessness 


5 nice 


1 smiling 


3 being 


8 cute 


4 home 


6 noise 


3 soft 


1 bib 


1 cuteness 


3 human 


1 noisy 


2 softness 


Ibig 






3 nuisance 


2 squalls 


1 birth 


4 darling 


168 infant 


7 nurse 


1 squeal 


1 blessing 


1 daughter 


1 infinitesimal 




1 squealing 


1 blue 


1 delicate 


10 innocence 


2 offspring 


1 stout 


2 body 


1 dirty 


4 innocent 




1 sunshine 


1 bonnet 


1 doll 




1 pacifier 


23 sweet 


2 born 


6 dress 


7 joy 


1 paper 


7 sweetness 


6 bottle 




1 jump 


2 person 


1 syrup 


32 bov 


1 embryonic 




2 pink 




1 bread 


1 eyes 


4 kid 


1 play 


1 talk 


1 buggy 






1 pleasant 


1 talks 


1 bundle 


1 fair 


1 Iamb 


3 pleasure 


1 tiny 




2 family 


1 laugh 


1 population 


5 trouble 


1 cap 


5 fat 


2 laughing 


1 powder 


1 two 


3 care 


1 father 


1 Lawrence 


7 pretty 


1 wagon 
1 walking 
1 weak 
1 weakness 
1 wee 

1 white 

2 wife 

5 woman 


28 carriage 


1 feet 


2 life 




2 cart 


1 female 


1 light 


4 rattle 


239 child 
3 children 


1 flesh 
1 food 


12 little 
1 Lorenzo 


1 rocker 
1 round 


1 childhood 


1 friend 


9 love 


2 Ruth 


1 chubby 


1 future 


1 loveliness 




4 clothes 
3 comfort 


26 girl 


1 lovely 


1 sex 

1 sick 


22 cradle 


1 good 


2 mama 


1 sickness 


2 yell 


1 creation 


1 goodness 


4 man 


1 simple 


12 young 


1 crib 


1 growth 


1 mankind 


1 simplicity 


1 youngster 


1 crooning 




1 Mary 
91. MOON 


2 sister 


4 youth 


1 astronomer 


7 bodv 


1 circular 


1 delicate 


1 fair 


1 astronomy 


52 bright 


3 clear 


1 delightful 


2 fire 


1 atmosphere 


7 brightness 


2 clouds 


1 dim 


1 firmament 




1 brilliant 


4 cold 


4 distance 


10 full 


2 ball 




1 coldness 


1 dreaming 




2 beam 


1 calm 


8 crescent 


5 earth 


1 girl 


1 beama 


1 change 


1 cute 


3 eclipse 


1 globe 


7 beautiful 


4 cheese 




1 equator 


1 glowing 


6 beauty 


1 circle 


2 dark 


6 evening 


1 grand 



igioj 


GRACE HELEN 


KENT AND A. 


J. ROSANOFF 


9 


1 great 


3 lunar 


23 planet 


26 shine 


1 ateamur 


1 guard 




1 planets 


4 shines 


1 stone 




8 man 


1 pleasant 


12 shining 


2 struck 


3 half 


3 moonlight 




12 shiny 


120 sun 


2 heaven 


1 mountain 


1 quiet 


4 silver 


1 sweet 


3 heavens 

4 high 


1 mystery 




6 silvery 






1 reflection 


1 size 


1 turkey 


1 illumination 


1 necessary 


1 rise 


73 sky 






3 new 


1 rises 


1 Boiar 


1 valuable 


1 ladv 


66 night 


1 rising 


1 sound 




1 lake 




33 round 


1 splendid 


1 wan 


9 large 


1 object 




2 spoon 


2 water 


231 light 


1 ocean 


4 satellite 


1 spooning 


3 white 


3 love 


1 one 


2 sea 


32 star 


1 wish 


1 loveliness 


1 orbit 


1 see 


93 stars 




2 lovely 


2 pale 


1 seeing 

1 sentimental 

92. SCISSORS 


1 starlight 


H yellow 


1 apart 


3 dressmaking 


1 instruments 


1 nippers 


1 skirt 


4 article 


5 dull 






1 spool 






66 knife 


6 paper 


23 steel 


2 barber 


1 edge 


6 knives 


1 point 


1 string 


I blade 


1 fate 


1 lever 


1 pointed 


2 tailor 


1 blades 
1 blunt 


1 firecrackers 
1 flowers 


1 linen 
1 lost 


1 razor 
1 ruching 


3 thimble 

4 thread 


35 cloth 


2 garments 


2 machine 


1 Sarah 


1 tongs 


1 clothing 


1 glistening 


1 material 


1 screw 


10 tool 


1 cord 


5 goods 


1 metal 


1 severing 


1 tools 


1 crooked 


1 grating 


1 millinery 


2 sew 


1 trousers 


2 crossed 


7 grind 


1 mother " 


10 sewing 


1 useful 


347 cut 






190 sharp 


1 usefulness 


114 cutting 


1 handle 


1 nails 


5 sharpness 


1 utensil 


1 cutlery 


1 handy 


1 necessity 


1 sharpen 








4 needle 


40 shears 


1 weapon 


1 dress 


6 implement 


4 needles 


2 shut 


1 woman 


2 dressmaker 


36 instrument 


1 nickle 
93. QUIET 


1 silver 


2 work 


1 action 


3 demure 


2 life 


3 pleasure 


3 solemn 


• 2 alone 


1 disposition 


1 like 




2 solitude 


1 always 


1 docile 


1 loneliness 


1 quick 


3 soothing 


1 asleep 


1 dreary 


3 lonely 


2 quite 


4 sound 




1 dull 


2 lonesome 




2 soundless 


2 baby 


1 dumb 


1 looks 


1 rabbits 


1 speechless 


1 beautiful 




1 lovely 


1 refined 


1 state 


1 beauty 


8 ease 


48 loud 


1 relief 


2 steady 


1 bed 


1 easiness 


1 low 


6 repose 


136 still 


2 behave 


49 easy 




1 reserved 


16 stillness 


3 boisterous 


5 evening 


1 man 


68 rest 


2 study 


1 bore 




1 melancholy 


4 resting 


1 stupid 


1 boy 


1 family 


1 mind 


19 restful 


1 subdued 


I breeze 


1 feeling 


1 Miss K. 


2 restless 


1 summer 


1 brook 




1 moon 


6 room 


1 Sunday 


1 butterfly 


1 genteel 
3 gentle 


1 mountains 
1 music 


1 rough 


2 sweet 


20 calm 


1 gentleman 


1 myself 


1 sad 


2 talk 


1 cattle 


2 girl 




1 sea 


1 time 


6 child 


7 good 


1 nature 


1 serene 


1 times 


1 children 


1 green 


2 nice 


1 sheep 


1 timid 


4 church 




38 night 


1 sickness 


1 tomb 


1 color 


1 happy 


50 noise 


13 silence 


1 tranquil 


2 comfort 


2 harmless 


16 noiseless 


15 silent 


1 tree 


1 comfortable 


1 harsh 


1 noisiness 


24 sleep 


1 twilight 


1 composed 


1 heaven 


113 noisy 


3 sleeping 




2 contented 


fi home 


1 nook 


1 sleepv 


1 village 


21 country 


1 hour 




8 slow ' 


1 violent 


1 Creal 


3 house 


1 park 


1 slowness 


1 voice 


1 cricket 


2 hospital 


26 peace 


1 slumber 




3 cross 


1 humble 


2 peaceable 


1 slumbers 


1 walk 






52 peaceful 


1 smart 


1 water 


3 dark 


1 joy 


4 peacefulness 


1 smooth 


1 well 


1 darkness 




2 people 


1 sober 


1 Wilton 


3 dav 


1 landscape 


1 person 


10 soft 


1 wish 


2 death 


1 laughing 


4 place 


1 softly 


1 wood 


1 degree 


1 library 


4 pleasant 


1 softness 


10 woods 



94 



A STUDY OF ASSOCIATION IN INSANITY 



[July 







94. GREEN 






8 apple 


1 definite 


1 grew 


1 ocean 


1 sky 




6 dress 


1 grief 


1 olive 


1 slow 


2 beautiful 
1 bird 


2 earth 


1 ground 


2 orange 


1 small 
1 soft 


13 black 


3 envy 


1 hat 


3 paint 


2 sour 


1 bloomy 


1 Erin 


1 hill 


2 paper 


1 spinach 


2 blotter 


4 eyes 


2 horn 


1 peaceful 


9 spring 


46 blue 


1 farmer 


1 horrid 


2 peas 


1 stain 


1 book 
5 bright 
8 brown 
1 butterfly 

1 cabbage 


1 favorite 
12 field 
10 fields 

3 flae 

4 flower 


1 hue 

6 Ireland 
14 Irish 


11 pink 
6 plant 

1 plants 

2 pleasant 
1 pleasing 


1 summer 

1 tea 
10 tree 
29 trees 


1 calm 


2 flowers 


1 jealousy 


4 pretty 


1 unripe 


1 carpet 
1 cheese 


2 foliage 
1 food 


1 landscape 


6 purple 
2 quiet 


1 vegetable 


3 cloth 


1 foolishness 


1 laurel 


1 vegetables 


200 color 


1 forest 


5 lawn 


42 red 


3 verdant 


1 colors 


3 fresh 


8 leaf 


6 restful 


1 verdure 


1 comfort 


1 fruit 


13 leaves 


2 ribbon 




1 com 




4 light 


2 ripe 


1 warning 


1 country 

1 pnTPtmia 


1 Kay 
1 glasses 


1 meadow 


2 sea 


1 wearing 
31 white 


9 (^npnmhpr 


1 eold 


1 meadows 


4 shade 


1 wood 


1 curtain 


1 grand 
1 grapes 


2 mountain 


2 shamrock 
1 shutters 


2 woods 


8 dark 


284 grass 


1 name 


1 sight 


54 yellow 


1 Dartmouth 


5 gray 


4 nature 
95. SALT 


1 silk 


1 young 


1 acrid 


1 dish 


1 Lake 


2 potato 


IS sour 


3 air 


1 drink 


1 life 


4 potatoes 


5 spice 


1 apple 


2 dry 


1 lot 


1 powder 


1 spill 


2 apples 






1 preparation 


1 stickiness 


1 article 


5 earth 


4 mackerel 


2 preservation 


88 sugar 




17 cat 


1 marsh 


1 preservatives 


1 sustenance 


1 barrel 


7 eatable 


18 meat 


1 preserving 


27 sweet 


1 barren 


8 eating 


1 meats 




1 Syracuse 


1 bath 


2 eggs 


1 medicinal 


1 quotation 




1 beef 


1 epileptics 


1 melt 


1 refreshing 


14 table 


40 bitter 




2 mine 


4 relish 


2 tart 


1 bowl 


1 flnish 


3 mines 


7 rock 


87 taste 


1 box 


4 fish 


37 mineral 


1 rocks 


1 tasting 


2 bread 


21 flavor 


1 mustard 




2 tasteful 


2 brine 


3 flavoring 




1 saline 


6 tasty 


1 bromide 


46 food 


1 NaCl 


1 saltpetre 


1 tasteless 


7 butter 


1 France 


5 necessary 


3 salty 


1 temper 




11 fresh 


3 necessity 


1 sandwiches 


4 thirst 


2 celery 




I needed 


1 Saratoga 


2 thirsty 


9 cellar 


1 glass 


1 needful 


1 saving 


1 trees 


2 chemical 


9 good 


1 nice 


10 savor 


7 use 
2 useful 


1 codfish 






1 savory 


2 condiment 


1 halite 


36 ocean 


18 sea 


1 cook 


1 ham 




12 season 


1 uses 


2 cooking 


4 hard 


1 pantry 


31 seasoning 


1 using 


1 cows 


1 horrid 


1 paper 


2 shake 


5 vegetable 


1 cream 




1 pasture 


4 shaker 


1 vegetables 




1 ice-cream 


142 pepper 


8 sharp 


1 victuals 


1 deposit 


1 ingredient 


1 petre 


1 sheep 


1 vinegar 


1 dieestible 




I physic 


1 smart 




3 dinner 


1 Kenilworth 


1 pickles 


1 snapping 


34 water 


1 dirt 


1 kitchen 


5 pork 


1 sodium 


2 wet 


1 disagreeable 




1 potassium 
96. STREET 


2 soup 


38 white 


lair 


3 boulevard 


1 byway 


1 confusion 


1 Devon 


18 aUey 


1 Bowery 




1 congestion 


1 direct 


6 asphalt 


2 boy 


10 car 


2 comer 


1 directions 


1 automobiles 


1 brick 


8 cars 


1 country 


4 dirt 


63 avenue 


2 broad 


1 carriage 


2 crooked 


5 dirty 


1 avenues 


fl liroadway 


82 city 


1 cross 


1 distance 




1 Brooklj-n 


1 Clarkson 


3 crowd 


1 drive 


1 better 


1 building 


7 clean 


1 crowded 


1 driving 


1 bitter 


1 business 


1 cleaner 




2 driveway 


12 block 


4 busy 


1 colors 


1 dark 


1 dry 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



95 



4 dust 


2 horses 


1 nice 


1 racket 


26 town 


5 duaty 


1 hot 


8 noise 


1 residence 


1 tracks 


1 dwellings 


11 house 


5 noisy 


91 road 


7 traffic 




21 houses 


12 nvimber 


4 roads 


3 travel 


1 earth 


1 hustle 


1 numbers 


2 roadway 


1 tree 


1 Eiprhty-sixth 
1 Eleventh 


3 land 


1 One-fifteenth 


1 see 


1 trees 

2 trolley 


1 Elm 


21 lane 


1 One-sixteenth 


1 shopping 


1 turmoil 


1 even 


1 large 


1 opening 


3 short 






1 length 




OR sidewalk 


1 vehicles 


1 fertile 
1 Fifteenth 

1 fine 

2 flags 

1 Forty-third 


1 level 

1 light 

2 live 

2 location 
1 lonely 
29 long 

5 Main 


11 passage 

1 passageway 

2 passway 

12 path 

2 pathway 
1 pave 


2 sidewalks 

1 Sixty-seventh 

2 Sixty-third 
2 smooth 

1 space 


9 village 

3 wagon 
2 wagons 

78 walk 

23 walking 


1 garden 
1 going 

1 gravel 

2 gutter 


13 paved 
25 pavement 


4 square 
8 stone 


2 walks 
1 Wall 


1 Market 
1 Maxfleld 
1 motion 


1 paving 
1 pebble 
1 Pecan 


8 stones 
17 straight 
1 sun 


1 Washington 
14 way 
1 wet 


1 hard 


1 mud 


22 people 


1 sweep 


I white 


1 heat 


1 musician 


16 place 


1 tenements 


35 wide 


1 Hester 


2 name 


2 pleasant 


1 terrace 


1 width 


7 highway 
1 home 


21 narrow 
3 Sew York 


1 pleasure 

2 pretty 

97. KING 


23 thoroughfare 


1 Woodhull 


1 Albert 


1 dog 


8 head 


8 majesty 


354 queen 


1 all 


1 duke 


1 helmet 


2 male 




3 Alphonso 




2 Henry 


43 man 


1 regal 


1 antiquity 


SO Edward 


2 high 


3 master 


1 regent 


1 Arthur 


11 emperor 


1 Holland 


1 mean 


8 reign 


4 authority 


3 empire 


1 honorable 


1 Midas 


1 rich 




20 England 


1 horrible 


49 monarch 


1 Richard 


1 bad 


1 ermine 




4 monarchy 


2 royal 


1 boss 




1 imperial 




5 royalty 


1 rnrd 


1 family 


1 inheritance 


1 nation 


10 rule 


1 cards 


1 farce 
1 first 


1 Italy 


1 nobility 


4 rules 






3 noble 


162 ruler 


1 chief 


1 fool 


1 John 


2 nobleman 




3 command 


1 foreign 
1 friend 


1 judgment 


1 none 


1 Saxony 


1 commanding 
9 commander 

2 conqueror 


1 garment 

2 George 


2 Kaiser 

1 king 

5 kingdom 


1 officer 
1 old 


2 sceptre 

1 slave 

1 somebody 


13 country 


1 glory 




8 sovereign 


1 court 


1 good 


1 large 


2 palace 


1 Spain 


1 courtier 


1 govern 


1 law 


6 person 


1 stories 


63 crown 


4 government 


2 leader 


1 picture 


2 subject 


2 crowned 


6 governor 


1 lion 


2 pompous 


1 supreme 




2 great 


1 lord 


18 power 




1 daughter 


1 greatness 


1 Louis XVI. 


4 powerful 


21 throne 


1 diamonds 




1 loyal 


4 president 


1 title 


1 dignity 


1 Hamlet 


1 princess 


1 town 


1 dislike 


1 happy 


1 majestic 
98. CHEBSB 


1 Prussia 


1 tiTant 


2 American 


1 corn 


1 Dutch 


5 green 


1 lump 




9 cow 




1 grocer 


2 lunch 


1 bacteria 


3 cows 


1 eagle 


1 grocery 




3 bad 


1 cracker 


67 eat 




1 macaroni 


2 beer 


30 crackers 


29 eating 


I ham 


1 maggot 


1 biscuit 


30 cream 


1 eaten 


2 hard 


2 maggots 


6 bitter 


1 creamery 


19 eatable 


1 head 


1 meat 


2 box- 


1 crust 


3 eatables 


1 heap 


25 mice 


SB bread 


9 curd 


1 edible 


2 hole 


1 microbes 


1 brick 


3 curds 


2 eggs 


2 holes 


1 raild 


136 butter 


2 cut 




2 holey 


106 milk 


2 buttermilk 


1 cutter 


1 factory 


1 hoops 


1 milky 


8 cake 

2 Caraembert 


4 dairy 

2 delicatessen 


2 fat 
1 feast 
1 fine 


1 hunger 
1 hungry 


1 mixture 

2 moon 
1 mould 


1 casein 
1 chalk 
1 cheesecloth 
1 chum 


1 derby 

2 diet 

1 digestible 
1 digestion 


1 fondness 
91 food 

2 fresh 

1 fromage de 


1 indigestion 
1 jam 
1 kind 


1 mouldy 
13 mouse 

2 mustard 


4 cloth 


2 dinner 


Brie 


4 knife 


1 nice 


1 cold 


1 dish 






1 nourishment 


4 color 


4 dislike 


15 good 


13 Limburger 


1 nutrition 



96 



A STUDY OF ASSOCIATION IN INSANITY 



[July 



9 odor 


4 rarebit 


1 salt 


2 solid 


1 tasty 


1 odorous 


8 rat 


8 sandwich 


5 sour 


1 thin 




7 rats 


2 sandwiches 


1 strengthening 




1 pickles 


1 red 


1 sauce 


12 strong 


5 vegetable 


6 pie 


1 resentment 


1 scent 


1 sugar 


1 vegetables 


1 plain 


1 rich 


2 Switzer 


5 supper 




1 plate 


4 Roquefort 


3 sharp 


2 sweet 


1 wafers 


1 poor 


1 rough 


1 skippers 


16 Swiss 


3 white 


1 poultry 


2 round 


33 smell 


1 Switzerland 


1 worms 


1 price 




1 smells 






2 product 


1 sage 


7 soft 
99. BLOSSOM 


8 taste 


32 yellow 


50 apple 


1 clover 


39 fruit 


2 odor 


1 seeds 


4 apples 


5 color 




2 orange 


1 shrubberies 


1 art 


1 colors 


2 garden 


2 orchard 


1 email 




1 country 


1 gin 




2 smell 


m beautiful 


1 dainty 

2 daisy 

1 delicate 


1 giri 


1 pansies 


1 soft 


9 beauty 


1 green 


1 p.-msy 


23 spring 


1 beRinning 


2 grow 


1 peacefulnesB 


1 sprout 


1 berries 


2 growth 


4 peach 


1 stem 


28 bloom 






1 petal 


4 summer 


7 blooming 


1 eat 


1 handsome 


1 petals 


1 sun 


1 blow 


2 fair 


1 happiness 


1 picking 


15 sweet 


1 book 


1 hepatica 


7 pink 




4 brierht 


1 falling 




13 plant 


1 T. 


23 bud 


1 falls 


3 leaf 


1 pleasure 


40 tree 


3 buds 


3 field 


1 leaves 


1 plum 


17 trees 


1 bursting 

1 bush 

2 bushes 


1 fields 

467 flower 

73 flowers 


2 lilacs 
1 lily 


1 pour 
15 pretty 


1 vine 
3 violet 


1 buttercups 


1 foliage 


1 magnificent 


3 red 


1 weeds 




2 forth 


2 May 


17 rose 


8 white 


5 cherries 


6 fragrance 


1 mimosa 


4 roses 




4 clierry 


4 fragrant 






2 yellow 


1 clematis 


1 frail 


1 nice 
lOO. APRAin 


1 scent 


1 youth 


1 accidents 


5 cowardice 


2 ghosts 


4 nervousness 


1 soldier 


1 action 


3 cowardly 


1 girl 


3 never 


1 somebody 


2 alarm 


1 crowd 


4 go 


12 night 


1 sore 


2 always 


1 crying 


1 goblins 


3 no 


2 sorrow 


3 anerer 




1 God 


1 nobody 


1 sorry 


2 anery 


15 danger 


1 guilty 


2 noise 


1 spirit 


2 animal 


2 dangerous 




1 noisv 


1 spiritual 


2 animals 


1 dare 


1 happy 


1 not 


1 startled 


1 anxiety 


114 dark 


2 harm 


5 nothing 


1 startling 


2 automobile 


16 darkness 


1 heart 




1 stav 


1 awful 


2 death 


1 heroism 


1 obsession 


1 stillness 




1 deep 


1 hide 


1 opposition 


1 strong 


1 backwardness 


1 depressed 


1 home 




1 suddenness 


2 bad 
2 bashful 


1 desire 


1 hope 


1 palpitation 


1 suflFering 


1 dislike 


1 horse 


1 patient 


1 sure 


1 battle 


1 do 


1 hurt 


1 patients 




1 bears 


1 dog 




1 plucky 


1 tempted 


1 blow 


1 dogs 


1 insect 


1 police 


1 terrified 


2 bold 


1 don't 


1 joy 
1 joyful 




9 terror 


1 boy 
18 brave 


1 doubt 
7 dread 


1 quiet 
1 rat 


3 thief 
1 thought 


1 bravery 

1 brother 
S burfflar 

2 burglars 


1 dreading 


1 licked 


1 rats 


1 threaten 


1 dreadful 
1 dream 

9 PTTiAfinn 


1 lightning 

3 lion 

1 loneliness 


1 retreat 

1 riot 

2 robbers 


1 thunder 
55 timid 

2 timidity 


1 careful 


ia dlJVJLlUll 


3 lonely 


I rocks 


1 timorous 


2 cat 


2 faith 


5 lonesome 


4 run 


1 to-night 


1 cheerfulness 


lf)7 fear 


1 loss 


1 running 


2 tremble 


8 child 


8 fearful 






1 trouble 


1 children 


8 fearless 


3 man 


1 scare 


1 trust 


1 cold 


2 feeling 


1 manner 


106 scared 


1 unable 


1 comfort 


1 fierce 


I memory 


1 scary 


1 uncertain 


1 comforted 


1 forward 


1 mild 


1 scream 


5 uneasv 


1 company 


fright 


1 Mtss K. 


1 sensitive 


1 unhappinesa 


1 confidence 


2 frighten 


1 mice 


1 shiver 


1 unknown 


1 conscience 


4S frightened 


2 mouse 


2 shrinking 


1 unprotected 


11 courage 


1 frightful 




1 shudder 


5 courageous 


1 frog 


1 need 


2 shy 


1 woman 


1 cow 




2 nerve 


1 sickness 


1 women 


1 rows 


1 gallant 


1 nerves 


1 sleep 


1 worried 


53 coward 


4 ghost 


55 nervous 




3 worry 



MILITARY PSYCHIATRY.* 

By R. L. RICHARDS, 
Captain Medical Corps, U. S. Army. 

The psychiatric picture differs in different races, different 
social classes, and in different environment. Thus, insanity in the 
Malay does not present the same picture that it does in the Cau- 
casian race. The tropical Malay has very little education and 
his life is monotonous, with none of the stimulus of varying sea- 
sons, with few bodily wants, and ven,^ little of the striving for 
existence. An inspection of seventy-five criminal insane in 
Manila, P. I., in 1905, showed the writer no excited cases. Some 
were apparently confused and many appeared demented. They 
were destructive and it was especially difficult to keep them 
clothed. They showed a larger percentage of stigmata of degenera- 
tion than the average Philippino. Dr. P. C. J. Van Brero,' in 
charge of an asylum at Buitenzorg, Java, says : " Their delu- 
■ sions are more elementary and often so little developed that in 
Europeans we should call them demented. I have never seen any 
obsessions and their expansive ideas are childish. While they are 
dangerous when excited, a larger number of natives and Chinese 
can be treated in a quiet ward than would be true among the same 
number of Europeans." Of 230 patients, 37 were discharged re- 
covered, 20 improved, 60 died, and 113 were remaining. Dr. M. 
Urstein,^ after studying mental cases in Central Asia, says : " The 
richness and intensity of symptoms were less .... Usually but 
one symptom was prominent .... Rarely was there a flight of 
ideas, although word pressure was evident .... The depressions 
showed much less affect disturbance." The Japanese are also said 
to require less restraint and to be more quiet. Steida' found in 
Japan only one isolation cell occupied, and that by a tubercular 
patient. Several centuries ago the Japanese people established 

* Read at the sixty-sixth annual meeting of the American Medico- 
Psychological Association, Washington, D. C, May 3-6, 1910. 



98 MILITARY PSYCHIATRY [July 

of their own accord, at Iwakura, near Kioto, an open-air method 
of treatment like that at Gheel. So little were they disturbed bv 
the insane that fifty years ago there were no insane asylums in 
Japan, and now we find only private asylums and one govern- 
ment asylum in Tokio. 

This difference extends even farther, for it is well known that 
different social classes give different pictures of mental disease. 
The elaboration and the definiteness of the delusions vary with the 
education and life of the people in the same mental disease. Even 
certain characteristics seem stamped on certain localities. Sev- 
eral authors have mentioned the unusual amount of simulation 
and the theatrical qualities of mental disease among Neapolitans, 
whose theatrical tendencies in ordinary life are so well known. 
Great catastrophies, such as the Messina' earthquake and the 
Carrieres" (France) explosion, have given rise to reports of psy- 
choses of a depressed character with delusions colored by these 
experiences. 

Consequently, it seems natural that we should expect to find in 
military organizations, composed of selected men, of the active 
period of life, for a special purpose and living under unusual con- 
ditions, certain special problems and manifestations. Our own 
country is nearly the last to take up this serious problem. As far 
back as 1786, Goercke," in Germany, invited the attention of the 
government to the special problems of the mentally diseased in the 
army. But it was not until nearly a century later, in 1870, that 
Koester succeeded in awakening practical interest. Meanwhile, 
Russia, because of overcrowding of civil asylums and other un- 
satisfactory conditions, determined to build an asylum for military 
insane at St. Petersburg, in connection with Nicolajewschen Mili- 
tary Hospital. This proved so satisfactory that in 1894 they 
opened a new building of one hundred beds, erected at a cost of 
$500,000. The Medical Chirurgical Military Academy in St. 
Petersburg has also erected a similar hospital, where Prof. Bech- 
terew has done his famous work. Besides, we find they have 
erected at least ten other military psychiatric hospitals in different 
parts of the empire. These all have to do with acute recoverable 
cases and chronic cases are provided for elsewhere. It is also to 
Russia's credit that in the recent Russo-Japanese ' war she gave 



igiO] R. L- RICHARDS 99 

the first practical demonstration of the necessity and importance 
of a complete psychiatric service from the firing line to the home 
hospitals. A specially-constructed ambulance with a surgeon and 
attendants collected the cases from the firing line and delivered 
them to one of two psychiatric dispensaries near the scene of 
battle. From this point they were assembled at a central psy- 
chiatric hospital at Harbin and later transferred to Russia. Way- 
station psychiatric hospitals were established to meet the neces- 
sities of the home journey of thirty days on the train. 

Austria has followed the example of Russia in establishing at 
Tyrnau ' a special psychiatric hospital under purely military con- 
trol. In this hospital they have abolished restraint, with the result 
that destruction of property has decreased 28 per cent. They 
employ in agricultural work 40 per cent of the patients, and the 
income in 1904 from this source was i8,0Ckd kronen ($3600.00). 

In Germany, all doubtful cases (i. e., cases where the diagnosis 
of mental disease is not clear) are kept in the psychiatric depart- 
ments of the military hospitals until the diagnosis is established. 
All cases in which the existence of mental disease is established 
are sent to civil institutions. According to their sanitary reports, 
the average time for observation of all cases has been forty-two 
days. Owing to the fact that asylums are plentiful, this scheme 
adapts itself to their immediate needs so far as the men are con- 
cerned, according to Stier.' But Stier claims that officers, and 
non-commissioned officers and old soldiers, presenting a larger 
percentage of chronic mental diseases, and the government being 
obligated to specially provide for them, should be retained in 
special institutions. Soldiers serving only a short period of re- 
quired service properly belong to civil asylums. Sommer and 
Shafer argue for the special care of all insane soldiers by military 
authorities, as occurs in Russia and Austria. It it noticeable that 
as the military surgeons learn more of military psychiatry, they 
take more and more care of the military insane. Thus at Charen- 
ton, which is designated to receive the military insane from Paris 
and its surroundings, those in authority have recently stated that 
they receive less and less military insane since the military sur- 
geon is better instructed on this subject. Since the mentally dis- 
eased are so often in conflict with military law and are entitled to 



ICX5 MILITARY PSYCHIATRY [July 

government compensation for any disability incident to the service, 
and since military conditions are distinctly different from civil 
conditions, it is always difficult and often impossible to equitably 
sever the soldier's relations with the military organization in the 
first few months of mental disease. 

France, Italy, Holland, Belgium, Spain, England, and the 
United States have followed and are following the Gennan plan 
of sending all cases of mental disease to civil institutions as soon 
as the diagnosis is established, providing the patient has not mean- 
while recovered, when he is discharged on certificate of disability. 

Naturally, all these countries have felt the need of special 
instruction of military surgeons on the subject of military psy- 
chiatry. Naturally, too, the instruction is more complete in pro- 
portion to the countries' knowledge of the subject. Where psy- 
chiatry is a closed book, except to a few who have given their 
lives to its study, there it is put aside as one of the things impos- 
sible to connect with the medical department of the army. 

Roubinovitch, recently in a personal letter to Granjux, explains 
the Russian method of instructing the military surgeon in psy- 
chiatry, as follows : 

At the Military Academy, the fourth-year students have theoretical in- 
struction once or twice each week. The fifth-year students frequent psy- 
chiatric clinics and assist in the examinations of patients. Especial lectures 
are given during the period preceding examination. Among the twenty- 
five young surgeons designated for work at the different clinics of the 
University of St. Petersburg, a certain number are assigned to psychiatric 
work. 

Germany, besides the psychiatric work in the regular course 
and the state examination, has a special three months' course for 
military surgeons at the Charite Hospital in Berlin under Prof. 
Ziehen. In addition, certain ones are assigned to psychiatric 
clinics for a period of two years. Austria has special instruction 
in the military hospitals, with departments for mental diseases, at 
Vienna and Budapest. Further special instruction is given as 
proves necessary. 

Italy assigns each year some young surgeons to the psychiatric 
clinics for two years. 

In France, Granjux,'" Regis," Rayneau,''' Simonin, Antheaume," 



I9IO] R. L. RICHARDS lOI 

and many others, liave given special attention to the psychiatric 
instruction of the military surgeon. Regis has a six months' 
course in his clinic for naval and army surgeons. The Congress 
of Alienists and Neurologists has passed resolutions covering 
necessary changes in the laws, and the government has taken the 
necessary action. As a result, the military surgeons themselves 
have done a great deal of special investigation of conditions and 
are taking more care of the military insane, as is evidenced by the 
statement quoted above from Charenton, that they are receiving 
fewer military insane from the Paris garrison than they formerly 
did, although statistics show an increase in the number of cases. 

Belgium has a special course of instruction at Hospital de 
Malines. 

Holland has some special instruction at the two asylums in 
Java. 

In England Psychiatry is one of the specialties available to 
military surgeons of a certain grade. 

Under the inspiration and direction of General Torney, our own 
army is entering upon a period of instruction for military surgeons 
at the Government Hospital for the Insane, and a general increase 
of a knowledge of psychiatric matters among military surgeons. 
Dr. William A. White has placed all the large resources of the 
above hospital at their disposal. The many acute cases (there is 
a yearly admission rate of more than 600), and the special oppor- 
tunities in the studies of the cerebrospinal fluid, of the histopathol- 
ogy of the cortex, and of the psychological laboratory, make this 
an exceptional opportunity. 

The following are the most important problems and phases of 
the situation confronting military surgeons from a psychiatric 
point of view : 

1st. Military insane are younger in years and show a higher 
recovery rate than do the civilian insane. Of 1102" enlisted men 
received directly from the active army, at the Government Hos- 
pital for the Insane in the period, 1899 to 1908, we find that 72 
per cent were under the age of thirty years, and 94 per cent under 
the age of forty years. That our recovery rate is high, is shown 
by the following table, comparing this class with the total insane 
population of the institution : 
8 



I02 MILITARY PSYCHIATRY [July 



Philippine Period 

1899-1903 


Quiet Period 
1903-1908 


Whole Period 
1899-1903 


Enlisted 

Men 

per ct. 


w. ] 
Hosp. 
per ct. 


Enlisted 

Men 
per ct. 


w. 

Hosp. 
perct. 


Enlisted W. 
Men Hosp. 
per ct. per ct. 


Discharged : 










(a) Recovered . . 64 


34 


49 


35 


57 34 


(b) Improved ... 8 


IS 


12 


IS 


9 16 


(c) Unimproved. 1.5 


2.36 


4 


2.74 


2 2.64 


Died 7 


32 
17 


6 


33 

15 


7 32 

25 16 


Remaining 20 


29 



Thus it is seen that the enlisted men alone average 23 per cent 
more recoveries than all the cases (civil, marine hospital, navy, 
and army) in the hospital. A further study of these cases showed 
that acute infectious diseases, sunstroke, or heat exhaustion, and 
alcohol were etiological factors in a series of cases, giving total re- 
coveries of 71 per cent, or 13 per cent more than the average for 
enlisted men, and 37 per cent more than the general average for the 
whole hospital. Besides, 189 cases were discharged recovered 
before reaching the Government Hospital for the Insane. This 
corresponds with the report of Dr. A. B. Richardson" to this 
Society covering the period of Cuban hostilities, namely, " Excit- 
ing causes operating for a limited period, such as produce exhaus- 
tion, or are the result of the toxic influence of specific poisons 
circulating in the system, produce a comparatively simple form of 
mental disturbance which tends to early recovery." 

2d. Because of the nature of military life, the military insane 
are potentially dangerous to a larger number of people. Up to 
the earlier period of the Roman Empire, armies existed for the 
purpose of carrying out someone's ideas of conquest and of pro- 
tecting the country against some threatening invasion. A per- 
manent or prepared army was not considered necessary. The 
battles were conflicts where individual strength and endurance 
counted for most. They were characterized by hand-to-hand 
encounters. Now it is a question of organization and fighting at 
long range. The latest German bullet is said to have a zone of 
deadly fire extending nine hundred yards in which a man cannot 
stand erect and remain alive. Larger bodies of men are engaged 
and the duration of a battle may be estimated in weeks instead of 
days. Troops must march long distances as rapidly as possible to 
take their positions in the firing line. It is needless to say that the 



igiO] R. L. RICHARDS IO3 

success of such an organization demands the previous training of 
its component parts and that there shall not be one weak pr.rt in 
the whole system. 

3d. After days and nights of marching and bivouacing, with an 
unseen enemy opposing with deadly fire the advance in this direc- 
tion or that, it is easily understood that only the strongest can 
successfully do their part and that the last atom of effort is being 
expended. No matter how carefully concealed under other cir- 
cumstances, any physical or psychical weakness is revealed at 
these times, and the psychical breakdown, in the nature of the 
case, requires more care than the physical breakdown. Psy- 
chiatrists " report that during the Russo-Japanese war they saw 
insane wandering about everywhere, in spite of the best psy- 
chiatric organization the world has ever seen. In one instance a 
whole regiment of Russians became infected with the fear that the 
Japanese having stopped their advance were about to open upon 
them with artillery fire. Officers and men ran as best they could 
for twenty-four hours, until checked by the main column. Psychic 
infection from the weaker ones seems the most reasonable explana- 
tion of this most remarkable occurrence. The large number of 
hysterical and exhaustion psychoses observed by the Russians 
show us what preparations we must make in the event of a modern 
battle. We know of no means of preventing the presence of some 
psychical weaklings at such a time. Even if it be a fact that they 
recover promptly, it is also admitted that they are especially liable 
to a recurrence if placed again in the same circumstances. One 
Russian officer, well known for his bravery, became afflicted with 
aphonia in each battle and led his men by means of signs. But 
finally he broke down completely and was sent home a nervous 
wreck. 

4th. Every civil community has its " queer " people. Their 
peculiarities are recognized and ignored. The positions they may 
fill are numerous and they form a useful part of their communities. 
An effort has been made in different countries to estimate the 
number of insane actually receiving institutional care. The con- 
sensus of opinion seems to be that this number is in the neighbor- 
hood of 66 per cent. But even recovered cases of mental diseases 
have been universally refused admission to armies. Germany re- 



I04 MILITARY PSYCHIATRY [July 

quires that all cases in institutions between twenty and forty years 
of age be reported to the proper authorities, and recovery from 
mental diseases, as well as any mental defect that would limit their 
serviceablcness, is a bar to duty in the German Army. The 
local authorities are supposed to report at the time of making up 
the list of conscripts any person whose peculiar conduct has been 
the subject of public notoriety. 

My own " investigations show that of the military insane re- 
ceived at the Government Hospital for the Insane, 13 per cent had 
had previous attacks of insanity, the pictures of 60 per cent showed 
stigmata of degeneracy, and 15 per cent had suspicious symptoms 
in the history of their previous life. From this it is evident that 
in a large percentage of our military insane, a careful examination 
and an inquiry into their pervious history would have led to their 
rejection at the time of their enlistment. 

5th. Psycopaths and weak-minded form a large part of the 
rejections in the German Army. Becker" has shown that they 
equal the number of cases of mental diseases and 78 per cent 
evidence cause for rejection in the first six months of their service, 
while in the same period only 61 per cent of mental diseases were 
evident. It was apparent from the previous histories of these 
cases that many of them had lived in more or less harmony with 
their environment and earned their living prior to enlisting in the 
service. But military life requires an accounting for each hour 
of the day and the performance of certain duties at the same time 
each day, as well as complete and unquestioning obedience to 
orders. Besides, men in the barracks are quick to discover the 
weaknesses of the individual and seek to correct them by making 
them evident. In the normal, faulty habits of life are quickly 
rectified in this way. But the psycopath and weak-minded con- 
sider this a form of persecution, seclude themselves from the 
others, absent themselves from the garrison, and finally often are 
guilty of desertion. The drill and sentry duty prove beyond their 
ability. The fatigue of maneuvers and active field duty are an addi- 
tional source of stress. Some of them develop an acute transitory 
psychosis. Looking at the question entirely from the standpoint 
of the individual, it is unreasonable to expect that he will be bene- 
fitted by army life. From the standpoint of defense of the coun- 



igiO] R. L. RICHARDS I05 

try, it is a crime to attempt to make use of any such inferior 
material. 

6th. Becker reports that a large number of the preceding class 
come under observation at Strasburg because of having been in 
conflict with military law. Of 500 discharges of soldiers coming 
directly from the ranks to the Government Hospital for the Insane 
in the period i860 to 1909, I find that 12.6 per cent were " dis- 
honorable," or " without honor " discharges, or had records of 
military offenses, chiefly desertion. Evidently the military insane 
and defectives come in conflict with military law more than the 
same classes of civilian insane and defectives come in conflict with 
civil law. Since laws are made to govern the individual so that 
he may live in harmony with his environment, it is natural that the 
special peculiar environment of military life should produce laws 
more difficult to observe by those who are opposed to any environ- 
ment that does not harmonize with their own distorted views. 
Hence the military surgeon will be obliged to aid in the solution 
of medico-legal problems, relatively more than the psychiatrist in 
civil life and usually where the opportunity for prolonged careful 
observation is not present. 

The remedies for all these problems peculiar to military psy- 
■chiatry are simple in prinicple, but difficult in application, and vary 
in different countries. They are usually divided under the follow- 
ing heads : 

I. Measures to avoid the enlisting of mental incompetents. 
This carries with it the idea of a standard of mental efficiency. 
The German Army orders on this subject specifically state that 
" existing or previous mental disease or any mental deficiency that 
would interfere with the serviceableness of the candidate " is a 
bar to enlistment. Our own standard, fixed by Congress, is simply 
that the candidate " must speak, read and write the English lan- 
guage," and that he must take out his first citizenship papers. 
Evidently poor cranial development, multiplicity of stigmata of 
degeneration, and peculiarities of manner and action would first 
attract the eye of the skilled investigator, and arouse suspicion. 
A knowledge of the previous life would show lack of reasonable 
mental attainments and lack of reasonable success in his previous 
environment. A mental examination and observation would de- 



I06 MILITARY PSYCHIATRY [Jill}' 

teniiine whether in all probability the candidate could adapt him- 
self to a military life. Such has been the method of procedure in 
other countries. In our own circumstances the three months of 
training at the recruit depot offer the best opportunity for investi- 
gation. We have not the police records, the list of those dis- 
charged from insane asylums, the reports as to progress in schools 
and the reports of clergy — all of which are available in European 
countries. We must depend chiefly upon our mental examination 
and general observation. 

2. In all countries it is found that with all the care possible in 
the examination of a large body of men in a limited time, some 
incompetents will escape. Consequently the less apparent cases 
will pass on to the company commander and the post-surgeon. It 
is also the universal experience that these two working in harmony 
can earlier detect incompetency and abnormality. This once estab- 
lished leaves the very simple remedy of removing them from the 
service. 

3. The next step of establishing the degree of responsibility of 
the service for the man's disability presents unusual difficulties 
from the fact that the etiology of mental diseases is not usually 
clear. The deciding of the relative value of the predisposing and 
exciting causes under which the disease arose is difficult to a 
trained observer with a lifetime of experience. Especially is it 
difficult in the early stages of mental diseases during which the 
military surgeon has the cases under observation. Fortunately 
the final decision in the case of an application for pension rests 
with the Department of Pensions, where the case can be fully 
studied. According to the present rulings of the Pension Depart- 
ment, mental disabilities are rated under the heading, " incapacity 
to perform manual labor (second grade)," which means $18.00, 
$24.00, or $30.00 per month. Those " requiring a special attend- 
ant " properly belong in the Government Hospital for the Insane. 
But the large number of recovered cases among the military insane 
form a class difficult to judge from the standpoint of " incapacity 
to perform manual labor." 

4. The last duty of the military surgeon is the helping to estab- 
lish the degree of responsibility of a military offender who has 



I9IO] R. L. RICHARDS lO/ 

any mental defect. The offenses recorded in the five hundred 
discharges mentioned above, were as follows: . 

Desertion 49 

Absence without leave 26 

Assaulting officer or comrade 21 

Fradulent enlistment 8 

Larceny 2 

Selling clothing 

False official statement 

Disobedience of orders in war time 

Embezzling 

Rape 

Disability, result of own misdeeds 7 

Not specifically designated 20 

Total 138 

In Dr. Becker's list of twenty-five cases with specialized 
oflFenses, the offenses correspond to the above, namely: 

Absence without leave and desertion 16 

Disobedience of commands 6 

Disrespect to superiors 2 

Assault I 

Total 25 

Evidently a knowledge of the conditions of military life is essen- 
tial in considering these cases. One very great advantage of the 
military surgeon is the better source of information under military 
conditions of the previous conduct of the offender. A disadvan- 
tage for the offender advanced by the French is that military sur- 
geons are more inclined to accept simulation of mental symptoms 
and not to recognize the degree of irresponsibility. In this con- 
nection Stier makes the point that in considering military offend- 
ers, the legal rather than the medical viewpoint must be assumed, 
since a military offense is relatively more serious and the effect 
upon the regard for authority among the other soldiers is more 
dangerous than in civil life. All of these points are in addition to 
the questions involved in the medico-legal aspect of civilian cases. 



I08 MILITARY PSYCHIATRY [J"ly 

LITERATURE. 

1. Ven Brero, Dr. P. C. J. : Algem. Zeitschr. fiir Psychiatric und Gericht, 

Vol. S3, 1896-97. 

2. Urstein, Dr. M. : Zentralblatt fiir Nervenheilkund und Phychiatrie, 

1906, S. 629. 

3. Steida, Dr. Wm. : Zentralblatt fiir Nervenheilkund und Phychiatrie, 

1906, S. 875. 

4. D'Abundo, Dr. G. : Revista Italiana de Neuropat., Psych, ed Electro- 

terap., 1909, Vol. II, fasc. 2. 

5. Stierlin, Dr. E. : Monatschr. fiir Psych, und Neurol., XXV, 1909. 

6. Wagner: Der Militararztliche Zeitschr., 1908, S. 145. 

7. Richards, R. L., Capt. M. C. U. S. A. : Mental and Nervous Diseases 

in the Russo-Japanese War. Military Surgeon, Feb., 1910. 

8. Zuzak: Militiirarzt, 1905. 

9. Stier, Ewald Oberarzt. : Ueber Verhiitung und Behandlung von Geis- 

teskrankheiten in der Armee. Hamburg, 1902. 

10. Granjux, Dr.: L' Alienation mentale dans 1' Armee, 1909. 

11. Regis, Prof.: L'Encephale. October, 1909. 

12. Rayneau, Dr. A. J. : Les Alienes dans 1' Armee au point de vue Medico- 

legal, 1909. 

13. Antheaume et Mignot : Les Maladies Mentales dans I'Armee Fran- 

^aise. Delarue, Paris, 1909. 

14. Richards, R. L,, Capt. M. C. U. S. A.: Military Surgeon. Nov., 1909. 

15. Richardson, Dr. A. B. : Transactions Amer. Med. Psych. Asso., 1902. 

16. Oserezkowski : Militarwochenblatt, 1906, No. 140. 

17. Becker, Theophile Oberstabarzt : Der angeborene Schwachsinn in sei- 

nen Beziehungen zum Militardienst, 1909. 

Government Hospital for the Insane, Washington, D. C. 



ALCOHOLIC AMNESIA AND AUTOMATISM.* 

By CHARLES W. PILGRIM, M. D., 

Medical Superintendent Hudson River State Hospital, Poughkeepsie, N. Y. 

Alcoholic amnesia and automatism are subjects of great interest 
to the physician, the lawyer and the layman. This is particularly 
the case where acts of a serious or criminal character have been 
performed, for here, in order to establish a scientific fact, we 
must overcome the deep seated convictions of the ordinary man. 
Under conditions where the victim has the greatest inducements 
to fabricate his case and to simulate his symptoms, it is extremely 
difficult to make the lay, or even the legal mind, understand that 
apparently rational, natural and even complicated acts may be 
performed by alcoholics when suffering from such a condition of 
amnesia as to make them utterly unconscious of what they are 
doing, completely oblivious of the results of their acts, and abso- 
lutely without remembrance of what they have done while in this 
dreamlike state. Within a comparatively short time three cases 
have come under my personal observation, which seem to me to 
be fairly typical examples of this interesting condition and, there- 
fore, worth recording. 

My first case was a man fifty-one years of age with a family 
tendency toward mental disease. He was a gentleman in appear- 
ance and manner ; a brain worker and a graduate of Union Col- 
lege. He gave a history of periodical excesses in the use of 
alcohol extending over a period of twenty years. Sometimes he 
would go two or three years without heavy drinking, but more 
frequently for only two or three months. He was a kind, affec- 
tionate man, and a devoted husband, except when under the in- 
fluence of alcohol. During the three years preceding my observa- 
tions he had been under treatment for alcoholism in two other 
State hospitals, and had also been, for short periods, in several 

* Read at the sixty-sixth annual meeting of the American Medico- 
Psychological Association, Washington, D. C, May 3-6, 1910. 



no ALCOHOLIC AMNESLV AND AUTOMATISM [J^^Y 

sanitariums. It was stated that ho would frequently disappear for 
days or weeks at a time and upon his return would have no 
recollection of where he had been or of what he had done. 

During his stay in the hospital he was quiet, gentlemanly, and 
well behaved, associating freely with the better educated patients. 
He spoke of imaginations of sight that he had had during delirium 
sometime before, but was free from delusions and hallucinations 
during the period of my observation. 

After a short residence in the hospital he was given a limited 
parole, upon the promise that he would not leave the grounds, 
but he soon violated his pledge and left surreptitiously. He de- 
liberately planned to avoid pursuit and went north to Kingston 
instead of south toward New York, which was his objective point. 

Upon his return to the hospital he said that he remembered 
taking several drinks in Kingston, but from that time until he 
came to himself two weeks later in New York he claimed that 
his memory was a complete blank. He could not remember arriv- 
ing in New York, nor could he recall any of the happenings of the 
previous two weeks. Later events made it probable that he had 
spent the most of this time in a disorderly house. A couple of 
weeks after his return an attempt was made by a woman to record, 
in the office of the county clerk, a deed of some property near the 
hospital. This deed was regularly executed, properly signed by 
the patient, and described with accuracy the transfer of a piece of 
property to which he had not the slightest claim. The date was 
that of the amnesic period, and the patient stoutly maintained with 
every evidence of sincerity, that he had not the slightest recollec- 
tion of ever having seen it. According to newspaper reports, sev- 
eral other deeds of a similar character came to light at a later 
period. 

He was taken home soon after his return to the hospital and 
since then nothing is known of his history. 

The case presented the ordinary symptoms of chronic alcoholism 
in an individual of neurotic tendencies, with slight deterioration, 
characterized by periodical exacerbations with amnesia. 

My second case is that of an Englishman, forty-nine years of 
age, who came to this country about thirty years ago. He came 
under my observation August 6, 1909. 

His family history was incomplete, but enough was learned to 



IQIO] CHARLES W. PILGRIM III 

make it certain that his father was an intemperate man who died 
in his early thirties as the result of an accident due to drink. The 
patient had a fair education and for the previous nineteen years 
had worked in hotels mostly in the capacity of a subordinate clerk, 
or an assistant steward, in charge of supplies. His wife stated 
that three years before admission he drank to excess, but so far 
as she knew he had partaken of stimulants only in a moderate 
degree for the year preceding his admission. Two months before 
coming to the hospital he began to suffer from symptoms of 
cirrhosis of the liver due to his previous excessive use of liquor. 
On July 21, he reported for duty at 6 a. m. at the hotel where 
he was employed, but told his employer that he did not feel 
well and asked to be excused from his work for the day. He had 
been complaining somewhat of languor for two weeks before, but 
had been able to attend to his work. Upon receiving permission 
to remain away he left the hotel and from that time nothing is 
known of his actions until the afternoon of the next day, when he 
went to the police station in Troy, which is about eighty miles 
from New York, and gave himself up. He stated that he could 
not remember his name, where he had come from or how long he 
had been in Troy. In fact, he could give no details in regard to 
his personal history. He was committed to the Rensselaer County 
jail and remained there until August 6, when he was sent to the 
Hudson River State Hospital under the name of John Doe. 
When admitted to the hospital he was still unable to tell any- 
thing about himself and apparently made every effort to recall 
past events. He was quiet, rather unsocial and a little depressed 
over his condition, but otherwise acted in a normal manner. 
He manifested diminished pain sensibility, absent corneal, and less- 
ened pharyngeal, reflexes. Having in mind hysterical influences, 
which the above mentioned symptoms suggested, he was twice 
hypnotized and brought under the influence of suggestion. He 
was told that he would be asked to name the letters of the alphabet 
and the suggestion was made that when he reached the letter with 
which his name began he would recall his name. When the 
experiment was continued upon reaching W he said that his name 
began with that letter, and finally gave his name, which did begin 
with W, and later on he recalled his home address and put us in 
communication with his wife, who had been anxiously searching 



112 ALCOHOLIC AMNESLX AND AUTOMATISM [Julv 

the metropolitan hospitals ever since his disappearance. Grad- 
ually he began to recall the past, first repeating the happenings 
of the two previous days, and then the ones preceding until the 
amnesic period was encroached upon as far back as the morning 
of his disappearance from New York, but he could never recall 
with any distinctness anything that happened from the time he 
left the hotel in the morning until he reached the station house in 
Troy. 

He remained under observation for about three weeks and 
during that time displayed no evidence of delusions ; his orienta- 
tion was correct and his memory for remote events quite good ; 
there were some evidences of hallucinations of smell, and during 
the amnesic period he saw ugly faces, but he was able to correct 
these impressions and recognized them as imaginations. His con- 
dition was diagnosed as one of hysterical amnesia with alcohol as 
an important factor in its production. 

The third case is that of a man thirty-nine years of age, who was 
employed in a shirt factory where he was recognized as a profi- 
cient cutter. The family history shows that the father 'died of paral- 
ysis and that a maternal cousin died in a hospital of a deteriora- 
tion psychosis. The patient received a common school education, 
and began his factory work when 15 years of age. At the age 
of 17 he began to drink beer in moderation and perhaps two or 
three times a year would become intoxicated. When about 21 
he began to dabble in spiritualism and developed the idea that he 
possessed mediumistic powers to a considerable degree. Later he 
travelled around the country giving exhibitions of clairvoyance, 
mind reading, etc. Seven years ago he began to use liquor to ex- 
cess and his alcoholic habits reached their maximum about three 
years before admission. About two years ago he began to be 
troubled by the face of a woman which appeared over his left 
shoulder. This face was a fantastic one and did not resemble that 
of anyone he had ever known. He claims that when he drank to 
excess he did not see this face and gives this as an excuse for his 
intemperate habits. During this period his amnesic spells also 
began. Generally they would last only an hour or so, and he thinks 
that they were at first periods of preoccupation rather than periods 
of distinct amnesia, but in the winter of 1908- 1909 he had an attack 
of complete amnesia which lasted two days. On Saturday and 



igiO] CHARLES W. PILGRIM II3 

Sun(iay he had been drinking freely and the events of Monday 
and Tuesday were a complete blank. On Wednesday morning he 
went to the factory in fear and trepidation fully expecting to be 
discharged for his fancied absence on Monday and Tuesday. But, 
much to his surprise, the foreman said nothing to him. He then 
began to make cautious inquiries of his fellow workmen and found 
that he had been at work on Monday and Tuesday and that no one 
had noticed anything peculiar in his actions. His fellow workman 
at the cutting machine said that he had been rather quiet, but, aside 
from that, he had performed the usual amount of work in his cus- 
tomary manner. Thus for two days his actions had been purely 
automatic and natural enough to pass unnoticed by his daily asso- 
ciates while he was in a state of complete " dream consciousness." 
Similar amnesic periods of shorter duration occurred from time to 
time when he would have no recollection of what he was doing, 
although his work would be done in the usual way, up to Novem- 
ber, 1909, when the second prolonged period occurred. For nearly 
a week he had been drinking heavily, and on the Monday preceding 
his admission he started for the factory at the usual hour, but 
returned to his home within a short time saying that he did not 
feel well enough to work. His wife said that he lay down for a 
while, but soon got up and after a dispute, chased her out of 
the house. He then returned to his room and later in the day his 
daughter found him hanging by a clothes line from a door. The 
physician who was called advised' that he be sent to the jail, 
where, it is said, that he was quiet for a while, but later became 
excited. The patient himself had no recollection of anything that 
happened from Sunday morning until Tuesday afternoon when 
he found himself scantily clothed walking around in his cell. 
When admitted to the hospital he was greatly concerned over his 
condition and wanted to be treated for it and expressed a willing- 
ness to stay until cured. For a period of three months the patient 
was unable to recall a single event from Sunday morning to Tues- 
day noon. It was then thought best to try to synthetize his 
memory by h}'pnoidal influences, according to the method of Sidis. 
Three trials were made before the events were completely re- 
called. After an hour's effort the events of Sunday were recalled, 
but as the patient was fatigued and the recollections came very 
slowly the session was terminated. A few hours later another 



114 ALCOHOLIC AMNESIA AND AUTOMATISM [J"ly 

trial was made and the events of Monday, from early morning to 
the time of the attempted suicide, were recalled in proper se- 
quence. A few days later a third trial was made. All efforts 
failed, however, to penetrate the blank following the suicidal 
attempt, although there were a few hazy recollections of Tuesday 
morning. Tuesday afternoon's events were not a part of the 
period of amnesia, for they had been clear in the patient's mind 
from the time of admission. 

His story of the events which he had hitherto been unable to 
recall were, in brief, as follows : 

After leaving home Sunday morning he visited a saloon and 
went to his mother's house where he had dinner. In the after- 
noon he went for a walk and in the evening made a call. He slept 
at his mother's house that night and in the morning started out 
prepared for work. He visited several saloons before reaching 
the neighborhood of his shop, and by that time was somewhat in- 
toxicated. He left for home, had an argument with his wife 
about insurance premiums, attempted to assault her with a pair 
of shears, and, when she escaped from the house, went upstairs 
to bed. He awoke in the evening about dusk, prepared a clothes 
line with which to commit suicide, and found a peach basket upon 
which to stand. This was not stout enough, as it collapsed under 
his weight, and he took a wooden box, adjusted the noose and 
kicked the box from under him. The last thing he recalls is try- 
ing to get his hands into his pockets so as to prevent himself 
from grasping the rope. 

The attempt at suicide was so nearly successful that the first 
physician who called suggested that a coroner be notified, but 
eventually tlie patient was resuscitated and taken to jail. This 
was Monday night and the events from the suicidal attempt, until 
the clear events of Tuesday afternoon, are shadowed by amnesia 
explained by the serious and nearly effectual attempt at strangula- 
tion. All other events were recalled with considerable distinct- 
ness and were given with a wealth of detail. His statements 
were later submitted to his wife who verified them in every 
essential point. 

He remained under observation for about four months and 
since leaving the hospital nothing has been heard of him. The 
general air of abstraction and preoccupation, with the lack of real 



igiO] CHARLES VV. PILGRIM II5 

interest in his home afifairs, the continuous reaction to visual 
hallucinations, and the tendency to explain his difficulties on a 
spiritualistic basis, would seem to point to a diagnosis of a serious 
disorder, probably along the lines of a dementia prjecox deteriora- 
tion process. 

These three cases are similar in many respects to the cases 
described by Dr. VV. C. Sullivan, of the Pentonville prison, Eng- 
land, to whom, probably more than to anyone else, we owe our 
clinical knowledge of the impulsive and automatic acts of the 
chronic drunkard. 

There are many points of similarity in these cases ; they all 
possessed a certain amount of education and intelligence which 
enabled them to lend co-operation in the study of their cases ; none 
had committed acts of sufficient gravity to warrant legal prosecu- 
tion, and, therefore, had no great inducement to fabricate and 
deceive ; and each had some nervous instability to predispose to 
the amnesia and automatism which became prominent under the 
influence of alcohol. 

Crothers considers this last point a very important one and says 
that " this trance condition will always be found associated with a 
peculiar neurotic state, either induced by alcohol, or existing before 
alcohol was used." 

Alcoholic amnesia may be partial or complete, in fact the per- 
centage of cases where the amnesia is partial is higher than it is 
in epilepsy. The less complete it is the greater the difficulty in 
establishing its existence in medico-legal cases. In some cases 
the experiences of the amnesic period may be recalled for a time 
and then be completely forgotten again. Sullivan quotes a case 
from jMaschka's Handbuch in which a man after committing- a 
homicide said, " Don't tell anyone about this," and later on com- 
pletely forgot the act. He also says that threats in advance of 
an impulsive act are no evidence of premeditation for " the fixity 
of the morbid condition in which the impulse has its origin is 
likely to give to action in the automatic phase a continuity with 
that in the waking consciousness which is easily construed into 
premeditation." 

Modern authorities do not believe that amnesia is either synony- 
mous or identical with unconsciousness, but that it means merely 
the submerging of a certain patch of memories into the sub- 



Il6 ALCOHOLIC AMXESLV AND AUTOMATISM [Jl'ly 

conscious mental life. A similar belief is also entertained in re- 
gard to the automatism associated with amnesia. It is thought 
that there is always a certain amount of consciousness present 
and that the psycho-pathological basis is probably due to a disso- 
ciation of consciousness. In other words, as Dr. Coriat expresses 
it, instead of being in an unconscious condition the patient is in 
a condition of other consciousness, for which he is amnesic in his 
ordinary waking state. 

The question of the proper psychological treatment is one of 
importance, for it is known that when the upper consciousness is 
rendered weak or inert by experimental distraction, or by the in- 
duction of the hypnoidal state of Sidis, " the subconscious mem- 
ories surge up, break through the strata of the upper conscious- 
ness and become manifest." Coriat believes that many cases will 
not recover except under proper treatment and that cases of 
spontaneous recovery from the condition of amnesia are extremely 
rare. These theories are certainly very fascinating and are of 
the utmost importance in medico-legal cases where the defense 
is along the lines of irresponsibility due to so-called automatic 
states. Of course in such cases the history of the patient should 
be very carefully gone into, and when there is a history of chronic 
drunkenness or epilepsy, with evidences of instability of the ner- 
vous system, and a history of previous automatic acts, then the 
defense of alcoholic automatism with amnesia should not be lightly 
brushed aside, but should receive most careful attention from all 
who believe in the just administration of our laws. 

There is still another case to which I should like to briefly call 
your attention, although it occurred as far back as 1785. We all 
know that a certain amount of amnesia and automatism are com- 
mon phenomena of ordinary intoxication, and nowhere have I 
seen a description of this condition which equals in literary flavor 
and subtle humor that given by Alexander Coventry in his 
" Journal of a Scotch Medical Student." In describing a visit 
to his uncle he says : 

It was 2 p. ni. when I reached Musselburgh, and between that and Inver- 
esk I met my uncle, who said he had some business to transact in town 
which would not detain him, and dinner would be ready on our return. 
We stopped at a tavern, and there my uncle met Mr. Dalloway, from the 
green isle, an old acquaintance, a painter; past times and old scenes were 



igio] CHARLES W. PILGRIM II7 

talked over; we had whiskey punch; cheese and cake were brought out, 
punch was succeeded bj' porter, and the latter retired by oporto, dinner was 
forgotten, or supplied by the oat cake and cheese, the usual accompaniment 
of sociability in a Scotch tavern. I ate a light breakfast and had taken a 
long walk, and the mixture of liquors began to affect my stomach and head, 
they being little used to such diet. I had sense enough to see that a short 
time would put me Itors dc combat, and I would be drunk at a tavern. I 
sought the back door. In a high wall opposite I observed a white stone; 
could I walk across the lane and put my hand on it I concluded, by keeping 
it close aboard, it would bring up short any lee lurch I might make to star- 
board, thus giving me some chance of reaching port without capsizing, for 
the wall continued to Inveresk and within a few yards of my uncle's. The 
experiment succeeded, my hand touched the stone, and I started within two 
feet of the wall. This was my last consciousness until on Sunday morning 
I found myself in bed with my clothes on, having simply removed my boots. 
I had found the bed where I usually slept at my uncle's and had lain down 
upon it. The period from my starting from the white stone in the wall to 
my awaking in the morning is a perfect blank in my existence, of which I 
have not nor ever had any consciousness, yet my uncle's man informed me 
that I had reached the room and went to bed without assistance. It was 
like the delirium of fever, it made no impression, it left no trace behind. 
According to this, my experience, is not the savage's reasoning more just 
than that of civilized man? An Indian does not resent an injury done when 
the aggressor is intoxicated. The Indian says, " Rum did it." It may not be 
safe to consider it as an aggravation because it might be simulated, yet the 
malice prepense is no more founded than in the maniac. From the time I 
started from the white stone to the next morning I might have committed 
a dozen murders and yet been unconscious of hurting a fly. Although the 
period alluded to seems a blank in my existence, the suffering of the next 
morning is too deeply impressed ever to be erased from the tablet of 
memory. 

And let us hope that this assertion was strictly true and that 
the disagreeable experience, so interestingly described, kept him 
ever after from following in the footsteps of his illustrious 
countryman who found his greatest pleasure in 

" Bousing at the nappy 
An gettin' fou and unco happy." 

REFERENCES. 
Alcoholic Automatism, by W. C. Sullivan, Journal of Mental Science, 

April, 1904. 
Dissociated Memories in Alcoholic Amnesia, by Isador H. Coriat, Journal 

of Abnormal Psychology, August, i8g6. 
Outlines of Psychiatry, by Wm. A. White, M. D. 
Journal of a Scotch Medical Student, edited by L. M. A. Liggett. Medical 

Library and Historical Journal, January, 1904. 



A STUDY OF THE DEMENTIA PR;EC0X GROUP IN 
THE LIGHT OF CERTAIN CASES SHOWING ANOM- 
ALIES OR SCLEROSES IN PARTICULAR BRAIN- 
REGIONS.* 

By E. E. southard, M. D. 

CONTENTS. 

I. The Schism o^r Dementw Pit«co.x 121 

Intoxication or dissociation. 

Apparent hopelessness of cortical cytopathology. 

Satellitosis of the deeper cortex layers (,'Mzheimer). 

French confirmation. 

Sioli's findings. 

Alzheimer's proof that dementia praecox is an organic psychosis. 

Differentiation possible between katatonic and maniacal excite- 
ment. 

Similar disintegration products in the brains of katatonia and of 
toxic delirium or severe visceral disease. 

Hirntod. 

Terminal infections in the insane remarkably common (Danvers 
data). 

Acute cytopathological changes must remain hard to interpret. 

Stratigraphic alterations (deep-layer satellitosis) important, but 
also not differential. 

The topographic idea in the anatomical investigation of dementia 
praecox. 

II. M..\TERI.\L, WITH ST.^TISTIC.^L ANALYSIS 127 

Sixty-three cases of probable or possible dementia praecox. 
Classified by age at death. 
by age at onset, 
by duration of symptoms. 
Superficial analysis into forms. 
Brain weights by sex. 

by age at death. 

by clinical forms. 

by duration of disease. 
Heart, liver, spleen, and kidney weights. 
Summary. 

* Read in part at the sixty-sixth annual meeting of the American Medico- 
Psychological Association. Washington, D. C, May 3-6, 1910. To be pub- 
lished also in the " Boston Medical and Surgical Journal " as part of the 
Charles Whitney Page Series of Danvers Hospital Laboratory Papers, 1910. 



120 A STUDY OF DEMENTIA PRECOX U^^Y 

III. Gross Anatomical Analysis of the Brain Findings 132 

Object of the analysis. 

Exclusion from prior consideration of cases of coarse cerebral 

atrophy. 
Exclusion of cases showing focal destructive arteriosclerotic 

lesions. 
Exclusion of cases of chronic diffuse leptomeningitis. 
Dural and calvarial conditions. 

Nineteen out of thirty-seven cases show macroscopic lesions. 
Pre-Rolandic group. 
Post-Rolandic group. 
Infra-Sylvian group. 
Cerebellar group. 
Other macroscopic cases. 
General grouping: i, complicated cases (excluded from prior 
consideration (40 per cent) ; 2, cases with minor macroscopic 
lesions (31 per cent) ; 3, cases without observed macroscopic 
lesions (29 per cent). 
Clinical analysis of thirty-seven chosen cases, with elimination of 

eight. 
Fifty-two per cent of non-complicated chosen series show macro- 
scopic lesions. 
Incidence of tuberculosis in this series. 

of other somatic complications. 
Summary. 

IV. Clinical and Anatomical Analysis of Fifteen Cases of De- 

mentia PR.ECOX Selected as Showing Certain Minor 
Gross Lesions of the Nervous System 138 

Correlations. 

Condensed histories and autopsy protocols in fifteen cases. 

The question of congenital anomalies vs. acquired lesions. 

Summarized impressions of each case. 

Acquired lesions probable in fourteen, congenital in eight, of 
fifteen cases. 

Anatomo-clinical correlations. 

Pre-Rolandic group, with frontal-paranoid correlation. 

Post-Rolandic group. 

(a) post-central — superior parietal — katatonic correlation. 

(b) occipital subgroup. 
Infra-sylvian group. 
Cerebellar group, katatonic. 

Provisional grouping of fourteen cases without recorded gross 

lesions. 
Four cases in which gross lesions should probably have been 

recorded. 
Probable actual proportion of gross lesions in our series 68 

per cent. 



igiO] E. E. SOUTHARD 121 

Necessity of intensive inspection and palpation of brains at au- 
topsy. 

Probable actual proportion of gross and microscopic lesions in 
our series 86 per cent. 

V. The Topographic Ide.\ in the Study of Dementia Pilecox and 

Allied Conditions i68 

Brain " changes " in functional psychoses. 

Is insanity brain-disease? 

If insanities are brain-diseases, the hrain-parts involved should be 
specified. 

Wernicke's generalization. 

The diabetes mellitus analogy — mental symptoms not necessarily 
cerebral, as glycosuria not renal in origin. 

Universal cytopathological changes not likely in dementia prsecox. 

Analogy of dementia praecox and general paresis. 

Random blocks of brain tissue, showing satellitosis, infrastellate 
gliosis, or disintegration products, not likely to solve prob- 
lem of pathogenesis of symptoms. 

VI. Conclusions 172 

I. The Schism over Dementia Precox. 

When it became apparent that the psychiatric world must needs 
split over the genesis of dementia prjecox, one party describing 
it as a species of intoxication with brain damage and the other 
as a dissociative mental disease without structural damage to the 
brain, one found one's mind almost wholly open in the matter. 
Perhaps, at the outset, one was not quite ready to admit dementia 
praecox (Kraepelin's disease) among such relatively immortal 
entities as general paresis and hysteria, for example. The dis- 
sociation hypothesis possibly seemed the wider of the two, per- 
mitting each case to be a law unto itself in such wise that a proper 
diagnosis really turned into a fairly full katamnesis. 

In any event it was gratuitous to hypothecate a toxine toto 
coelo and much more innocent to assume dissociations, especially 
if one could give precise descriptions of these for a number of 
typical cases. To be sure, some workers asserted characteristic 
satellitoses and other evidence of neuronic disease in the lower 
cortex-layers of the cerebrum ; but these findings were perhaps 
inconstant, probably shared by other types of disease, possibly 
secondary either to the disease or to something else, and certainly 
incapable of affording any explanation of the mechanism of 
dementia praecox. 



122 A STUDY OF DEMENTIA PR.TiCOX [July 

If one scanned the situation in neuropathology, the outlook was 
not bright. Restricting oneself to the cerebral cortex alone, 
cytopathology appeared to have fallen on evil days. Nissl had 
given up his specific nerve-cell intoxication pictures. Alz- 
heimer's methods for split products of nerve-cell metabolism had 
not been developed or fully applied. And. in any case, the effects 
of terminal complicating disease (intestinal, pulmonary, bladder, 
and the like) with a variety of intercurrent infections and intoxi- 
catons seemed to render dubious the outcome of almost any 
strictly cytopathological study, at least such as would contem- 
plate symptomatic correlations. To conceive a " katatonic storm " 
sweeping through the cortex and leaving behind it a characteristic 
trail was within reason, but surely difficult of proof in the midst 
of so many cortical storms about the point of death. 

Stratigraphic considerations were more hopeful. In fact, ever 
since Alzheimer's brief paragraph in 1897 — Ebcnso findet sich 
ganz zzveifellos bei der Katatonic cine patlwlogische Gliafaser- 
bildung in dcr Rindc, anschcincnd aitf gezvisse Rindcnschichten 
{und die Marklcistc) beschriinkt^ — there has been an ever re- 
current assertion that satellitosis and correspondent nerve-cell 
disorder of the inner cortex-layers are characteristic of dementia 
praecox, or at least of its katatonic form. In fact these findings 
were supposed to draw together the two diseases, dementia prscox 
and general paresis, since both showed the same changes, com- 
plicated in the latter by a multitude of other stratigraphic changes 
as well as by exudation. 

Such opinions are not confined to Germany. Thus, in France, 
Klippel and Lhermitte, 1908,' consider dementia prtecox to be due 
to a progressive atrophy of the association neurones. The lesions 
of dementia prsecox, they say, are all essentially neuroepithelial, 
i. e., confined to nerve-cells and neuroglia, and never essentially 
vasculoconjunctive, or, as we should express it, ectodermal, never 
mesodermal. The fundamental lesion is " a regressive atrophy of 
the nerve-cells of the deep cortical layers and disappearance of 
the interconnecting processes," with neuroglia proliferation run- 
ning pari passu with the atrophic process. Meningovascular 
lesions, miliary hemorrhages, congenital malformations, terminal 
lesions due to cachexia or infection, are frequent, but are not in- 
dispensably found. Even cerebellar atrophy, and various instances 



igio] E. E. SOUTHARD I23 

of visceral hypoplasia, are simply signs of frail organisms, which 
either precede without causing dementia praecox or are purely in- 
cidental effects thereof. Klippel. in discussion, admitted that 
similar neuroepitheliae (ectodermal) lesions were found in other 
chronic mental diseases. 

Perhaps no work has been more widely quoted in this direction 
than that of Sioli, done partly at Munich under Alzheimer and 
partly at Bonn and summarily reported in 1909. Sioli's state- 
ments refer, however, only in part to stratigraphic considerations. 

Sioli in his brief Autorcferat, 1909,' states that he found m all 
parts examined of 20 cases of dementia prsecox certain evidences of 
destruction of nerve tissue. A portion of Sioli's data is cytopatho- 
logical (nerve-cell disease with increase of Scharlach-stainable 
lipoids), but he indicates that the process may lead to atrophy or 
disappearance of cells, amounting in places to distinct strati- 
graphic disorder. Degenerative products were found accumulated 
in clear non-cellular spaces about the vessels, and protagonoid and 
Scharlach-stainable substances were found in tissues and in ad- 
ventitial cells en route to the vessels. Inflammatory exudation 
was quite lacking. Perivascular and periganglionic glia-cell pro- 
liferation, fibrillary gliosis in the subpial zone, in deep cortex- 
layers, and in the white matter, alterations of glia-cell cytoplasm, 
amoeboid neuroglia in the white matter occurred. The severest 
cases, especially those with their perivascular spaces packed with 
degeneration products, are thought to correspond with acute 
katatonic exacerbations. 

Alzheimer, in his masterly statement concerning split products 
of nerve-cell and fibre metabolism, 1910,' maintains that much 
new light has been thrown, by his new methods and adaptations 
of old ones, upon such conditions as status epilepticus, severe 
paralytic attacks, deliria, and katatonic excitements, and he be- 
lieves that anyone using these methods will be convinced that 
dementia praecox and epilepsy are severe organic diseases. Alz- 
heimer would almost risk differentiating histologically between a 
katatonic excitement and a mania, because the katatonic case will 
show characteristic amoeboid glia-cells, whereas the mania will 
not. For the purpose of this differentiation, severe disease of the 
other viscera must not step in to complicate the picture since 
such disease may bring out the amoeboid glia-cells in the nervous 



124 A STUDY OF DEMENTIA PR.ECOX [July 

system. Again, a severe toxic delirium at its height and a severe 
katatonic excitement at its height will exhibit similar changes 
(just as the posterior columns of a tabes and a spinal transsection 
might be confused under certain circumstances from the granule- 
cell content of both). The fact seems to be that "organic" 
changes can now^ be demonstrated in a number of conditions 
formerly termed " functional." The differentiation of katatonia 
remains difficult, however, on account of precisely the conditions 
mentioned by Alzheimer, toxic delirium and severe bodily dis- 
ease, which may produce somewhat the same pictures. 

One remarkable case of sudden death in a stuporous katatonic 
who had no demonstrable physical disease is mentioned by Alz- 
heimer to show that, without loss of any nerve-cell or degenera- 
tion of a single axis-cylinder, a true Hirntod may occur due to 
changes demonstrable by methods for the split products. 

Unfortunately for the neuropathologist, such cases of pure 
Hirntod are rare. In the Danvers State Hospital material, infec- 
tion at the time of death is almost the rule. Exact experiences 
with the cultivation of the more easily growing organisms from 
the blood and cerebrospinal fluid in 150 unselected cases have 
been communicated by Gay, Canavan, and myself." Cerebro- 
spinal fluids are particularly prone at death to show organisms. 
This experience, as well as an inspection of the great members of 
tuberculous and acute infections in our material, caused us to dis- 
count in advance the cytopathological change per se and to hold 
somewhat in doubt the acute or recent neuroglia change as in- 
dicating mental disease. The asserted stratigraphical changes 
(cell-atrophies and losses in lower cortex-layers and correspond- 
ent satellitosis) seemed more trustworthy, but obviously less dif- 
ferential (seen also in general paresis and in some senile cases). 

The status of the dementia praecox question may be summed 
up as follows : 

One body of workers prefers to describe dementia praecox in 
such terms as dementia sejunctiva (Gross'), Missverhdltniss 
zwischen Affekt und Vorstellung (Kolpin"), dysphrenia (Wolff"), 
dementia dissecans (Zweig"), schizophrenia {Zcrreissung od£r 
Spaltung der psychischcn Fnnktionen) (Bleuler"), Apraxia ideor- 
trix (Dromard"), emphasizing in general the dissociative factors 
which emerge upon psychological analysis of the more clearly cut 



IQIO] E. E. SOUTHARD 125 

cases. " Disruptions of judgment," " specific factors in individual 
cases," " unpsychological reactions," " intrapsychic ataxia " or 
more specifically " noothymopsychic ataxia," " intrapsychic in- 
hibition," " psychogenic conflicts," " psychological dispositions," 
" psychic causes," " psychic trauma," are phrases picked almost 
at random from certain modern discussions." 

Other workers pin their faith to the supposed " organic " char- 
acter of this disease. The ground of this belief is often scarcely 
more than that the disease is essentially deteriorative on the 
mental side and hence must be " organic " on the cerebral side. 
Others set much store by autointoxication and believe that the 
effects of autointoxication must be registered in the cerebral cor- 
tex, could we but read it aright. Proceeding from the dictum that 
insanity and, therefore, dementia praecox are brain diseases, these 
workers argue that dementia praecox is presumably a destructive 
disease of the cerebral cortex, after the manner of general paresis. 

A few workers accord significance to both the functional psy- 
chic features and the organic cortical features. There is, how- 
ever, a general tendency to take sides, with the almost universal 
feeling that the histologists have not satisfactorily proved the 
" organic " nature of the disease. 

1 was instigated to the analysis of my own material by the con- 
viction that, though the histopathologists had not proved their 
point beyond peradventure, the functionalists were in the same 
plight. I had been engaged upon an analysis of cases of mental 
disease with onset after the fiftieth year,"" and had there come 
upon so many instances of satellitosis in the deeper layers of the 
cortex without distinct katatonic features clinically that I had 
been disposed to discount the differential character of deep-layer 
gliosis for any type of mental disease. This reaction, in brief, 
appeared to be a necessary and natural result of destructive proc- 
esses involving these layers, and the deposition or increase of 
neuroglia cells in this locus did not assume to my mind the dif- 
ferential character of such findings, as, e. g., the plasma cell 
exudate of general paresis. Even the plasma cell, as all will admit, 
is not scnsu strictiori pathognomonic for general paresis (witness 
trypanosomiasis, not to mention tuberculous and frankly luetic 
processes). Gliosis of the deep layers of the cortex is obviously 



126 A STUDY OF DEMENTIA PR.ECOX [July 

far less differential than plasma cell exudation, if only because nor- 
mally we find neuroglia and satellite cells in this region. 

Feeling a deal of uncertainty about the differential value of 
stratigraphic alterations and especially of satellitosis, I was also 
not disposed to believe that dementia prascox would turn out to be 
a diffuse cell disease. All that Alzheimer maintains, if I under- 
stand him aright, is that anyone who chooses to examine dementia 
praecox material by certain methods can convince himself that it 
is invariably an " organic " disease.'' It would be a much longer 
step to assert that the changes invariably found are differential 
changes. Indeed, deliria and severe physical disease are consistent 
with the same changes. 

Neither stratigraphic changes nor cytopathological changes, 
taken as exhibited throughout a brain, appealed to me as likely to 
throw much light on the immediate mechanism of dementia prae- 
cox. Indeed these changes bring up more new problems than 
they solve old ones in the wide field of neurobiology. 

The topographic idea then occurred to me. In making, some 
years ago, an analysis of the first 1250 autopsies of the Danvers 
State Hospital and collecting the lesions of different parts of the 
brain in card-catalogue form, I had been much struck with the 
preponderance of brain lesions in certain areas. The frontal in- 
cidence was particularly high, and this, I took to be due to the 
greater liability of the frontal tissues (on the stock evolutionary 
grounds). Having no convenient opportunity to correlate these 
findings with clinical data (a want now happily supplied by the in- 
dex of clinical symptoms which Dr. Page has had constructed), 1 
did not further work up these relations. 

In connection, however, with work on encephalitis," on gliosis,^ ^ 
and especially on the " soft brain," ~ I had begun to gather un- 
usually careful data concerning focal and general variations in 
consistence of brains. I had, therefore, some hope that my series 
would prove unusually suitable for topographic study. 

Upon analysis, as the sequel will prove, not merely focal 
scleroses, but also easily identifiable macroscopic atrophies (or 
aplasias) were found in a surprisingly large number of cases. My 
topographic data depend, therefore, only in part upon the palpable 
mild scleroses which I had been especially studying. 



I9IO] E. E. SOUTHARD 127 

On the basis of the anatomical data and without necessarily any 
reference to microscopic studies (which have been carried out 
more or less thoroughly in the series), I wish to commend the 
topographic idea concerning lesions in dementia prsecox to neuro- 
pathologists. Whether a superior frontal atrophy or a postcentral 
aplasia is or is not superior to a psychic scar or ataxia, as really 
explanatory of the mechanism of dementia precox, I will not pre- 
tend to say. In any event, the brains of all dementia prsecox cases 
should be carefully examined. 

II. Materi.\l, with Statistical Analysis. 

The autopsy material of the Danvers State Hospital Labora- 
tory from May, 1902, to January, 1910 (including the services of 
Drs. A. M. Barrett, E. E. Southard, and a portion of Dr. H. M. 
Adler's), consists of 647 cases. Sixty-three of these have been 
chosen, on clinical grounds, as probable or possible examples of 
dementia praecox. The 10 per cent thus chosen constitute the 
maximum rather than the minimum number of possible cases, since 
it was thought best to include certain doubtful cases for purposes 
of comparison. As will presently appear, several of the cases are 
so clouded by other factors, such as certain congenital features, 
alcoholism, or attacks suggestive of manic-depressive insanity, that 
the diagnosis of dementia prsecox may appear extremely doubtful. 
It was felt that histological features might serve to extract the true 
cases. 

As it is extremely desirable not to confuse phenomena of a nor- 
mally aging brain with possible findings based on mental disease, 
the age of the subjects at death is important. The series is quite 
representative. 

TABLE I. 
Classified by decades according to age at death, the material shows: 

11 cases dying in the third decade (21-30)= 8 male, 3 female 

19 

12 " " " 
II " " " 

8 " " " 

2 " " " 

63 (21-80)= 33 " 30 



fourth " 


(31-40)= 7 •• 


12 ' 


fifth 


(41-50)= 3 '■ 


9 ] 


sixth " 


(Si-6o)= 6 " 


S 


seventh " 


(61-70)= 7 '• 


I ' 


eighth " 


(71-80)= 2 ■• 






128 



A STUDY OF DEMENTIA PR.BCOX 



[July 



It is also necessary to secure a representative series from the 
standpoint of age at onset. The series even includes two cases 
with strongly congenital coloring. 

TABLE II. 

Classified by decades according to age at onset, the material shows : 

2 cases with congenital features (possibly imbecile)=: 2 male, o female 

6 " " onset in the second decade (11-20) = 6 " o " 

28 " " ' third " (21-30) =13 " IS " 

20 ' " " fourth " (31-40) =9 " II " 

7 " • " " " " fifth " (41-50) = 3 " 4 " 



63 



33 



30 



It is essential to know how long the morbid process may be sup- 
posed to have lasted. Although many of these cases are not at 
all progressive, yet in many others slow transitions in clinical dis- 
ease-type are exhibited. The total durations are given in 

TABLE III. 

Classified by duration of symptoms in hemidecade periods, the material 
shows : 

18 cases under 5 years in duration 8 male, 10 female 

II " between 6 and 10 years in duration, 5 " 6 " 

10 " "11 " 15 " " " 3 " 7 

3 " " 16 " 20 " " " 2 " I 
7 " " 21 " 25 ' 4 " 3 

4 " " 26 " 30 " " " 2 " 2 " 
3 " " 31 " 35 " " " 3 " o " 
3 " " 36 " 40 " " " 2 " I 

1 " " 41 " 45 " " " I " o " 

2 " " 46 " so " " " 2 " o 
I " " 61 " 6s " •• " I " o 

63 33 30 



Although it is well known that various clinical phenomena are 
rather thoroughly commingled in this disease, making the older 
distinctions hard to maintain and more or less justifying Kraepe- 
lin in his union of types under a single caption, yet certain features 
do particularly characterize some cases, and the following table 
presents the impressions which these cases made, so to say, in the 
rough, before intensive analysis. 



igio] E. E. SOUTHARD I29 

TABLE IV. 
Superficial Analysis of Cases. 

Hebephrenic S cases, 2 male, 3 female 

Katatonic 17 " 9 " 8 

Paranoid 30 " 18 " 12 

Dementia-praecox-like : 

Imbecile I " I " O 

Alcoholic I " I " o " 

Manic-depressive, involutional 

and unclassified 9 " 3 " 6 

63 " 34 " 29 " 

There was such an admixture of symptoms in several of the 
cases, or symptoms of doubtful import, that possibly the katatonic 
cases should number 20, and the paranoid cases, 32. Imbecile traits 
came in question in seven cases in all, though possibly not to ob- 
scure the eventual diagnosis in more than three. Alcoholism can, 
with difficulty, be disengaged from the clinical picture of five cases. 
The at times doubtful, or eventually unclassified cases, which 
have been chosen to study with this group, number 15 ; but of these 
perhaps eight only can be fairly claimed as not instances of 
dementia prsecox ; and, if a somewhat liberal definition be admitted, 
all these cases will warrant consideration. As Table IV indicates 
52 eases (29 male, 23 female) probably belong in the group with 
some certainty on clinical grounds. 

In the process of anatomical analysis, much may be gained from 
the weight correlations of certain organs. If the brain weights 
stand up well, we at least have indication that no such conditions 
as those underlying general paresis or cerebral atrophy are present. 
The brain weights in this series correspond well with the normal, 
though they show a slight tendency to reduction (2 per cent). 

TABLE V. 
Brain Weights by Sex. 

Male (26 cases) 1336 dementia praecox, 1357 normal (Vierordt) 

Female (29 cases) 1218 " " 1235 

Differences 118 " " 122 

Percentages : 

Male 98% " " 100% " 

Female 98^0 " " 100% 

An analysis of the brain weights according to age at death yields 



130 A STUDY OF DEMENTIA PR-ECOX [July 

by no means so even a curve, doubtless because the numbers are 
too small for this particular purpose. The results are as follows : 

TABLE VI. 
Brain Weights by Decades in which Death Occurred. 

Male 21-30, 6 cases 1333 dementia praecox, 1358 normal (Boyd) 

1278 " " 1239 



Female 21-30, 


3 


Male 31-40, 


5 


Female 31-40. 


II 


Male 41 -so. 


3 


Female 41-50, 


9 


Male 51-60, 


6 


Female 51-60, 


5 


Male 61-70, 


5 


Female 61-70, 


I 


Male 71-80, 


I 



1476 " " 1366 

1 194 " " 1222 

1350 " " 1348 

1237 " " 12 14 

1353 " " 1345 

1222 " " I22S 

1364 " " I315 

1 100 " " I2I0 

1390 " " 1290 



It might be suspected that the different forms of dementia prse- 
cox would lead to different degrees of brain-weight reduction. 
The weights in the hebephrenic, katatonic, and paranoid cases, in 
accordance with the clinical analysis of Table IV, have been 
arranged : 

TABLE Vn. 



Hebephrenic 


male 2 cases 




female 3 


Katatonic, 


male 9 " 




female 8 " 


Paranoid. 


male 12 " 




female 11 



1338 


1357 normal 


(Vierordt) 


1168 


1235 




* 


13-29 


1357 




' 


1 193 


1235 




( 


1309 


1357 




( 


1240 


1235 







The differences are all less than 70 grams, and the weights are 
consequently within five per cent of the assigned normals. 

Since the duration of the disease, though it certainly does not 
vary with the duration of any active process in all cases, might 
be supposed to bear some relation with the extent of any de- 
structive process, the weights have been arranged according to 
duration : 

TABLE Vin. 
Cases with duration under 10 years : 

Male 1331 

Female 16 cases 1223 

Cases with duration 11-20 years: 

Male 5 cases 1261 

Female 7 " 1243 

Cases with duration over 20 years ; 

Male 10 cases 1375 

Female 6 " 1 173 



1357 normal 


(Vierordt) 


1235 




" 


1357 " 




(( 


1235 




tt 


1357 




ti 


1235 " 




** 



igiO] E. E. SOUTHARD I3I 

Obviously these figures produce no even curve ; but, should they 
be confirmed by other material, the interference could certainly 
be drawn that these brains stand wear and tear particularly well. 

If such figures tend to show that no coarse katabolic efifects 
evince themselves in the brains of this group, it is interesting to 
inquire whether any evidence of such disorder can be traced in 
other organs by this method. 

TABLE IX. 
Heart Weights. 

Male 31 cases 281 

minus 3 hypertrophies (500+ g.).. 244 313 normal (Vierordt) 

Female 27 cases 264 

minus i hypertrophy 253 310 " " 

TABLE X. 
Liver Weights. 

Male 30 cases 1369 1579 normal (Vierordt) 

Female 28 " 1257 1526 " " 

TABLE XL 
Spleen Weights. 

Male 30 cases 160 

minus I case \vt. 870 132 149 normal (Vierordt) 

Female 27 cases 106 180 " " 

TABLE XII. 
Combined Kidney Weights. 

Male 31 cases 280 277 normal (Vierordt) 

Female 29 " 255 264 " " 

Tables IX to XII appear to show that certain organs of the 
trunk are more disposed to evince losses in weight than is the 
brain in dementia praecox. The kidney weights, however, stand 
up well. The weight of the spleen, as always, showed marked 
variations, and these variations largely depend probably on certain 
terminal conditions independent of mental disease. 

Reductions in average weights of heart and liver reach a little 
over eight per cent, for both males and females in both series. It 
is hard to draw a significant conclusion therefrom. 

To sum up the data of this section, we learn from a fairly rep- 
resentative series of cases of dementia praecox and similar dis- 
eases that a reduction in brain weight of two per cent is perhaps to 



132 A STUDY OF DEMENTIA PR.ECOX [July 

be expected in the total group, that the reductions in brain weight 
of five per cent occur in certain forms (here a larger number of 
cases is required for deductions), that the brain weights do not 
undergo progressive reduction with the duration of the disease, 
and that the hearts and livers of the series show in general a re- 
duction of eight per cent in weight. Since the weights of the 
trunk viscera probably vary rather uncontrollably in the present 
state of knowledge (the factors of muscular activity and of nutri- 
tion in these patients come particularly in question), it is plain 
that more stress must be laid on brain conditions. The brains 
must be approached, therefore, with the premonition that changes, 
if any, will be fine changes, and possibly qualitative and trans- 
formatory rather than destructive. 

III. Gross An.vtomical Analysis of the Brain Findings. 

As it is our object to show either, first, that there are no char- 
acteristic brain findings in this series of cases or, secondly, that 
there are characteristic findings common to the series, it is ob- 
viously necessary to exclude cases with certain features which we 
are sure are not characteristically allied with dementia praecox. 
Such complicating features are coarse cerebral atrophy and 
regionary arteriosclerosis. These features complicate and some- 
times influence the course of dementia praecox; but it is certain 
that arteriosclerosis and highly probable that coarse cerebral 
atrophy are not characteristically associated with the disease. 

As is well known, the question, whether brain atrophy exists, 
cannot be safely answered from the brain weight alone, since 
apparently high weights are consistent with atrophy of originally 
large brains, and apparently low weights may mean simply that 
the original weights were low. Qualitative data are safer guides 
here. 

Five brains gave the qualitative impression of generalised 



atrophy. 


All these cases were of long 


total duration (11 years 


or more). 


















TABLE XIII. 




AntnpBy CUnlcftl 
Number. Nuniber 


Sei. 


Age. 


Dl8«a9e-Type. 


DnratiOQ. 


Brstn 
Terminal Dlaease. WelgUt. 


752. 9888. 


F. 


64. 


hebephrenic 


9y- 


pneumonia, 7d. iioo. 


958. 10738. 


F. 


37- 


paranoid, 


liy. 


exhaustion, ini. 1210. 


1266. 7559. 


F. 


S8. 


paranoid, 


13 ++ y- 


dysentery, some weeks. 1250. 


1274. 1 1027. 


M. 


56. 


katatonic, 


3iy. 


hemiplegia, im. 1365. 


1297. 7511. 


F. 


47- 


paranoid, 


I9y. 


cancer of uterus, 2 -h m. 1390. 



I9IO] E. E. SOUTHARD 133 

It seems safe to eliminate this group from prior consideration, 
despite the fact that the gHosis shown may be more or less closely 
related with dementia praecox. 

One of the best indices of damaging local arteriosclerosis is 
afforded by cysts of softening, which were found in three cases, 
1274 and 1297 of Table XIII, and 1171 (5986, R, 43, paranoid, 
17+ (30?) v., brain weight Iii5g.), also excluded from prior con- 
sideration. 

Also it may be safer at first to exclude seven cases (1099, 13180, 
M., 67; 1 121, 13398, F., 56; 1 174, 9769, F., 48; 1258, 2, M., 64; 
1270, 617, M., 68; 1337, 15017, F., 45; and 1368, 12120, M., 56) 
on the score of marked sclerosis of vessels of the circle of Willis. 
It is certain that this sclerosis has no direct effect upon the mental 
life ; but there is at least a suspicion of vascular disease in the 
finer branches in such cases (only two of which in this series, viz., 
1337 and 1 174, are under 56 years of age). 

It is noteworthy that we are required to exclude on these 
grounds (grounds, namely, of complicating "organic" brain-dis- 
ease) only about 20 per cent of our series. This confirms the 
impression gained from our statistical analysis of the brain 
weights. 

There is another general condition, frequently found in cases 
of all descriptions (both sane and insane), which might be con- 
sidered to have some bearing especially upon the histology of the 
superficial layers — chronic leptomeningitis of diffuse distribution 
(to the focal distributions we shall return in a moment). Eleven 
cases (842, 904, 913, 943, 958, 1014, 1025, 1027, 1093, 1234, 1338) 
may be excluded on this ground. These 11 and four others 
(already excluded) yield another perhaps surprisingly small per- 
centage (about 22 per cent) of cases showing diffuse chronic 
leptomeningitis. 

For completeness are also presented the data concerning 
TABLE XIV. 

DURAL AND CaLVARI.\L CONDITIONS. 

Arachnoidal villi unusually developed 3 cases 

Thickening of dura mater (not included under adhesions) 4 

Chronic internal hemorrhagic pachymeningitis 3 

Dense calvarium 9 

Thick calvarium 6 

Thick and dense calvarium 2 

Thin calvarium 3 

Calvarial adhesions of the dura mater 25 

10 



134 A STUDY OF DEMENTIA PR^^ECOX [July 

If we rely upon the statistical analysis of Section II, we cannot 
be so sure that mild focal lesions of an atrophic or sclerotic nature 
have nothing to do with processes in dementia prsecox, since these 
lesions will not appreciably influence brain weights. It is, of 
course, d priori unlikely that such circumscribed foci, which are 
doubtless in the vast majority of instances due to some degree of 
local tissue destruction, can correspond with the extended series 
of vital reactions which we term dementia prsecox. Nevertheless, 
it is wise to examine our series carefully for foci of a slightly 
destructive or perhaps purely irritative character which might 
bear on the course of certain cases. 

Consequently, excluding as diffusely atrophic five cases, as 
markedly arteriosclerotic (cysts of softening or basal cerebral 
arteriosclerosis) eight cases, as showing diffuse chronic pial 
changes ii cases, we remain with a material of 39 cases, which 
deserve primary consideration from the standpoint of possibly 
significant focal brain lesions. Obviously the results of the search 
in these 39 cases (two of which must be excluded through in- 
adequate protocols) may be applied, with due caution, to the re- 
mainder. 

A group of 14 cases amongst these 37 " non-organic " cases 
showed certain minor lesions made out in the gross, but not 
frankly destructive, some possibly congenital in origin. A sum- 
mary view of these cases is presented in 

TABLE XV. 

Minor Macroscopic Brain Lesions in Dementi.^ Precox. 

/. Prc-Rolandic Lesions. 

Frontal Lobe Leslone. 

Atrophy and gliosis of 
frontal lobes. 

Gliosis of superior frontal, 
prefrontal, and orbital 

gyri. 
Gliosis of frontal, including 
orbital, gyri (v. also cere- 
bellum). 
1294. 10862. F. S7. paranoid, 6y. Frontal lobe gliosis (v. also 

post-Rolandic and cere- 
bellar groups). 

4y. Frontal lobe gliosis (v. 

postcentral group). 

loy. Gliosis of left inferior 

frontal lobe. 

loy. Atrophy of prefrontal gyrL 



AotopHy 

Number. 

840. 


CUnlciU 
Naniber. 

II-'II. 


Sex. 
F. 


ige. 
38. 


Disease-Type. 

katatonic, 


DaratloD. 

3y- 


1062. 


7987. 


F. 


38. 


paranoid 
(alcoholic) 


ii-i- 


II43- 


8823. 


F. 


47- 


paranoid or 
katatonic, 


loy. 



1310. 


13582. 


F. 


28. 


hebephrenic 
mannerisms, 


1358. 


10580. 


M. 


24 


katatonic, 


1360. 


10168. 


M. 


51- 


suicidal, 



IQIO] E. E. SOUTHARD I35 

//. Post-Rolandic Lesions. 

Occipital Beglon Qlioila. 

1137. 6531. M. 35. paranoid, later isy. Right superior parietal mi- 

katatonic, crogyria (atrophia?). 

1168. 11863. F. 24. hebephrenic 3^y. Bilateral aplasia of post- 
paranoid?, central gyri. 

1298. 14S91. F. 36. katatonic, lom Right postcentral atrophy 

(v. discussion). 

1310 See Frontal Group Left postcentral aplasia or 

atrophy. 

1149. I1641. M. 57. paranoid, 32y. Occipital region gliosis. 

1294 See Frontal Group Occipital region gliosis. 

1317. 12143. F. 44. paranoid, 2iy. Occipital microgyria. 

///. Infra-Syh'ian Group. 

Cerebellar LeBloDS. 

1319. 14597. F. 31. paranoid, 8y. Superior temporal anomaly, 

(imbecile) 

IV. Cerebellar Lesiotts. 

1034. 12756. M. 35. first paranoid 2y. Sclerosis of dentate nuclei 

later katatonic, of cerebellum. 

1 143 See Frontal Group Sclerosis of right dentate 

nucleus, culmena, and clivi 
of cerebellum. Pons and 
olives firm. 

116S See Post-Rolandic Group Sclerosis of right dentate 

nucleus, cacumena, and 
clivi of cerebellum. Scle- 
rosis of olives. 

A somewhat similar small group of four cases has shown certain 
appearances in the spinal cord, indicating abnormality of quite 
doubtful interpretation. 

TABLE XVI. 

Gross Lesions of the Spinal Cord. 

Autopsy Oltplcal 

Nnmber. Number. Sex. Age. Disease-Type. DnratloD. Gross Lesloos of the Bploal Cord. 

1317 See Post-Rolandic Group Cervical portion abnor- 
mally firm. 

1319 See Infra-Sylvian Group Cervical cord abnormally 

large. 

1335 See Table XVII Cord abnormally small. 

1350. 4820. M. 62. katatonic, 35 -i- y. Gliosis of lumbar spinal 

cord. 

Here then, as indicated in Tables XV and XVI, is a group of 15 
cases showing certain minor chronic lesions (or evidences of 
aplasia) in the central nervous system of quite doubtful, though 



136 A STUDY OF DEMENTIA PILECOX [July 

certainly very varied, origin. Adding four more cases of gen- 
ercdised cerebral sclerosis of a mild form, not associated with 
gross atrophy, viz, 

TABLE XVII. 

Aotopiy OUbIoaI 

Namber. Nomber. Sex. Age. DUaase-Type, Daratlon. 

991. 1 1047. M. 35. paranoid, iiy. Brain weight 1170 grams. 

1135. 11296. F. 28. katatonic, 6y. Brain weight 1430 grams. 

1303. 11624. F. 55. hebephrenic, 2Sy. Brain weight 1220 grams. 

1335- 13648. M. 32. katatonic 2oy. Brain weight 985 grams. 

(alcohoHc) 

we obtain a total of ip cases of slightly, though macroscopically, 
abnormul central nervous system in a series of 57 ca^es, selected as 
not showing coarse complicating features like brain atrophy, in- 
tracranial arteriosclerosis, cysts of softening, and the like. 

These 19 cases, or at all events a certain number of them, de- 
mand attention as a group of dementia praecox cases with lesions 
of doubtful interpretation, but not readily set aside as non- 
significant. 

If we should group our cases up to this point, we should obtain 
(i) complicated cases, showing gross lesions certainly not related 
with dementia praecox, 40 per cent, (2) cases with minor lesions 
having a doubtful relation to dementia praecox, 31 per cent, and 
(3) a residuum of cases without observed gross lesions, 29 per 
cent. 

It will be wise at this point to analyze the cases of groups (2) 
and (3), i. e., the non-complicated cases from a clinical point of 
view. The 37 cases are distributed as follows : 

TABLE XVIII. 

Hebephrenic 4 2 male, 2 female 

Katatonic 12 5 " 7 " 

Paranoid 13 7 " 6 " 

Alcoholic I I " " 

Doubtful 7 3 " 4 

If we eliminate the alcoholic (1240, no gross lesions) and 
doubtful cases (819, 939, 1151, no gross lesions; 1143, 1360, 
frontal lobe lesions; 1350, spinal cord lesion; 1 135, generalized 
gliosis. Compare Tables XV-XVII) for the time being, we 
obtain 52 per cent of our group (now reduced to 29 cases) show- 
ing minor lesions. 



I9IO] E. E. SOUTHARD I37 

A microscopic analysis of the 15 cases showing minor lesions 
may indicate what type of lesion to look for in those cases which 
failed to show gross lesions. Lesions of this sort should be 
demonstrable by any method which displays cells and nuclei well. 

In case the lesions should prove non-stratigraphical, i. e., not 
ideally demonstrable by complete cell-counting, the task will be 
more difficult. The qualitative intracellular or special extracellu- 
lar properties which this latter search would entail will require 
material very seldom obtained, material free from terminal com- 
plications. Cases hitherto reported have suffered perhaps from 
such terminal disease. Tuberculosis is a special offender in this 
direction. Tuberculosis occurred in our series as follows : 

TABLE XV. 
Tuberculosis in 63 Cases of Dementia Pilecox. 

Active forms 21 cases 

Healed and chronic forms 16 " 

All forms 37 " 

Tuberculosis in 39 Chosen Cases. 

Active forms 16 cases 

Healed and chronic forms 7 " 

All forms 23 " 

In both series there is 58 per cent of tuberculosis, counting all 
forms. One case in three of the whole series either died with or 
showed an active form of tuberculosis, whereas about two cases 
in five of our chosen " non-organic " series showed similar active 
tuberculosis. 

Whereas it has never perhaps been convincingly shown that 
active tuberculosis outside the nervous system can produce im- 
portant non-exudative lesions within the nervous system, it is 
probably a sound policy to exclude such cases from a list sans 
reproche, especially if intracellular conditions are to be studied. 
This process would leave us with 23 cases free from coarse de- 
structive brain lesions and from active tuberculosis. 

Nine cases showing decubitus, 10 cases of soft brain " (only 
one of which occurred in the non-organic series), and three cases 
of edema of brain substance might also offer obstacles to finer 



138 A STUDY OF DEMENTIA PRJECOX [July 

cytological analysis. For this purpose a list of 21 cases is avail- 
able; but clinical doubts and difficulties remove eight cases, leav- 
ing 13 cytologically appropriate cases (840, 884, 891, 944, 1006 
(typhoid fever), 1034, 1081, 1298, 1303, 1317 (carcinomatosis), 

1350, 1358, 1360). 

To sum up, we have divided our cases upon anatomical grounds 
into three groups, (i) cases complicated by gross destn.ictive 
brain lesions (40 per cent), (2) cases having certain minor anom- 
alies or mildly destructive or irritative lesions (31 per cent), and 
(3) cases without observed gross lesions (29 per cent). After 
excluding cases unsuitable for analysis on various grounds, we 
obtained a group of 29 cases, 15 of which (52 per cent) showed 
the minor anomalies and mild lesions just mentioned. It will 
be the task of the next section to study these 15 cases intensively 
to see whether they evince any common features. Later studies 
may then apply these observations to the rest of the series, in 
which significant lesions may well occur hidden among com- 
plications. 

IV. Clinical and Anatomical Analysis of Fifteen Cases 
OF Dementia Pr.«cox Selected as Showing Certain 
Minor Gross Lesions of the Nervous System. 

At this point it seems pertinent to inquire whether, upon a 
closer analysis of the cases which show minor gross lesions or 
anomalies, any hint of correlation between these lesions and in- 
dividual clinical phenomena can detected. It must be pointed 
out forthwith that no very close correlation can be hoped for, 
since we deal with far less constant phenomena than, e g., those 
of epilepsy. The histories, presented below in as condensed form 
as deemed advisable to offer a sound basis for clinical diagnosis, 
obviously betray far greater variations in course and qualitatively 
more complex features than would a similar number of histories 
of epileptics. But clinical and anatomical correlations even in 
epilepsy are difficult, despite the firm establishment of the " un- 
cinate " group on an anatomical basis. In view of the clinical 
variety of the dementia prjecox group, or even of the group of 
cases characterized by katatonic symptoms, it is at the outset 
doubtful whether a " frontal lobe group," a " postcentral g^oup," 



I9IO] E. E. SOUTHARD 139 

a " cerebellar group " can be firmly established for dementia prse- 
cox. Obviously such a grouping should be earnestly essayed. 

The condensed histories, drawn from the records of numerous 
workers (among whom may be mentioned Drs. H. W. Mitchell, 
H. A. Cotton, H. M. Swift, and Charles Ricksher, who have been 
at the heads of the various services during the major part of the 
time covered by these reports) and the summarised autopsy 
protocols (for which the pathologists, bacteriologists and assist- 
ant physicians named below have been responsible) are here 
presented. 

Case I. — S. M., D. S. H., No. 12211, Path. No. 840. Female, 37, single, 
school-teacher. Born in Cambridge, Mass., of Irish parentage. Was a case 
of dementia prsco.x, katatonic type, of three years duration. 

Heredity. — Negative. 

Previous History. — Patient taught school from 22-35. In August, 1901, 
after a period of over-work, the patient became depressed (" had lost her 
soul"); her mind' dwelt on suicide. Patient remained unoccupied; two 
weeks after onset of depression was committed to McLean Hospital, where 
she showed languor, slow movements, little spontaneous talk, a general 
effect of emotional gloom and certain somatic delusions ("bowels gone"). 
A brief attack of excitement followed, with confusion and resistiveness. 
Short periods of excitement followed with later increasing inertia, and 
little spontaneous talk. Seven weeks after commitment she began to show 
increase of muscular tension and had to be tube-fed. 

Patient was transferred to Danvers Hospital April i, 1903, and then 
showed a flushed face, clammy skin, and considerable acne. Pulse slow and 
weak, respirations shallow. 

The katatonic signs consisted of an evenly distributed increase of mus- 
cular tension. Patient lay constantly in bed, on one side, with arms loosely 
adducted, hands clenched, legs flexed, chin and knees drawn together, 
eye-lids tightly closed, a fi.xed facial expression, with lips protruded. 

At first patient would take food from a cup, but tube-feeding was later 
constantly resorted to. 

Patient would flinch slightly to pin pricks, but would not move limb even 
if pin was deeply thrust. Risus sardonicus appeared at times. Occasion- 
ally, the eye-lids were kept half closed, and the eye-balls rolled upward. 

Within six weeks, a slight physical failure was noted. Patient would 
occasionally speak at night. Later, talking spells occasionally appeared, 
such as " Go away," " Stop that," " Oh, what shall I do ? I can't read. 
Oh, a thousand times. It is nothing at all " ; or again, " I shall have to 
stop in this bed forever. God Almighty in Heaven, here I am talking, and 
I have no head. I am as empty as space. There is nothing in this bed, 
and I have no head. I have fixed everything wrong. It is terrible. Look, 
I am talking without a head. It is impossible. Is it not? An empty bed. 



140 A STUDY OF DEMENTIA PRECOX [July 

I am a skeleton bitch. This is a frightful impossibility." Looking at her 
hands she said, " These are not hands. How can I do this talking without 
a head? God help me. It is all wrong. I simply imagine that I see them. 
There is nobody here, the bed is empty. I don't know what I am doing." 

Emaciation became rapid late in 1903, and patient died after a period of 
continued fever. 

An.\tomical Diagnosis (A. M. Barrett). 

Cause of Death. — Phthisis pulmonalis. 

Chronic Conditions. — Poor musculature. Malnutrition. Bilateral chronic 
adhesive (apical and posterior) pleuritis. Tuberculous cavity of apex of 
left lung. Cavitation and disseminated tuberculosis of upper lobes of 
both lungs. Enlarged bronchial lymph nodes. Bronchitis. Chronic fibrous 
("milk patch") pericarditis. 

Recent Conditions.— {"Poa'AXy bronchitis and bronchial lymphnoditis). 
Fatty liver (microscopic evidence). Fatty kidney (microscopic evidence, 
slight). 

Nervous System. — Brain weight 1090 grams. Generalized increase of 
consistence of brain. Slight visible atrophy of gyri of both frontal regions. 
Cerebral cortex unusually dark in color, but without puncta cruenta. 

Case II.— P. F., D. S. H., No. 10147, Path. No. 991. Male, 35, married, 
carpenter. Born in Nova Scotia of Nova Scotian parents. Was a case of 
dementia prsecox, paranoid type. 

Heredity. — Negative. 

Previous History. — Masturbation ; sexual excess. At 21 years married ; 
five children. At 31 years " nervousness," loss of confidence, somato- 
psychic delusions ("heart gone," " insides working"). In hospital quiet, 
apathetic, hypochondriacal. Discharged at 35 and next year recommitted. 
Diagnosis, hypochondriacal paranoia. The diagnosis was later changed 
to chronic melancholia. Emaciation and suspicion of phthisis at 38 years. 
Signs of phthisis upon recommitment at D. S. H., October 25, 1902. Ex- 
tremities blue, teeth poor. At first refused food. Groaning and complaints 
of pain and abnormal sensations. Disorientation (lack of interest?) for 
time and place. 

" I can't speak because it pulls down and pulls up, and is wound around 
me." At no time katatonic signs, except mutism (possibly paranoidal 
origin). 

Anatomical Diagnosis (A. M. Barrett). 

Cause of Death. — Phthisis pulmonalis. 

Chronic Condition. — Malnutrition. Poor musculature. Chronic oblitera- 
tive pleuritis, bilateral. Phthisis pulmonalis, with cavitation and fibrosis. 
Chronic persplenitis. Chronic interstitial nephritis. Exostosis on inner 
surface of frontal bone. Adherent dura. 

Acute Condition. — Acute fibrinous pericarditis (organism of colon 
group). 

Nervous System.— 'Brum weight 1360 grams. Slight generalized cerebral 
gliosis. 



I9IO] E. E. SOUTHARD I4I 

Case III.— R. O., D. S. H., Nos. 11871, 12756, Path. No. 1034. Male, 3s, 
single, shoe-factory operative. Born in Italy. Was a case of dementia 
prsecox, at first paranoid, later katatonic, of two years duration. 

Facts concerning heredity unknown. 

Preznous History. — Emigrated from Italy at about 23. Shoe-factory 
operative of average capacity. Easily affected by alcohol (some beer and 
whiskey daily). In March, 1904, stated that anarchists and socialists 
wished to kill him; that he heard men talking and singing in the next 
room ; thought that people were going to " do him," and ceased to work 
steadily. In the course of five or six weeks patient began to feel that his 
friends had turned against him, and when a man borrowed his mandolin 
and returned it minus one string, patient reasoned that he was being 
hypnotized. At that time, the diagnosis lay between dementia prscox and 
alcoholic insanity, the former preferred. 

Patient was committed to Danvers Hospital April 27, 1904. Under- 
sized, unusually hirsute. There was slight swaying in the Romberg posi- 
tion. The knee-jerks were exaggerated. Patient was reticent. At one 
time said, " There is going to be something this side and then on the 
other side," making signs with his fingers around his head. Once asked 
to play cards, snatched the cards from the table and refused to give them 
up. Dulness and inactivity increased, with a tendency to stupor, inter- 
spersed with brighter intervals. Nine months after admission, periods 
with marked echopraxia and some cerea flexibilitas, with diminished 
response to peripheral stimuli, set in. Patient became reluctant to eat. 

Discharged February 2, 1905, to go to Italy. Patient was readmitted 
October 5, 1905, with mutism, cerea flexibilitas, slight resistiveness on 
being roused, fixed facial expression, staring eyes and pouting lips. Slight 
albuminuria was now demonstrated for the first time. Automatism shortly 
developed, with prompt obedience to commands, such as protrusion of the 
tongue for incision. Patient habitually sat for hours with hands spread 
over knees, staring at the floor. Saliva was held in mouth for hours. 
Symptoms of pulmonary gangrene set in and patient died a week later, 
January 23, 1906. 

Anatomical Diagnosis (E. E. Southard). 

Cause of Death. — Gangrene of right lung. . 

Chronic Conditions. — Emaciation. Unequal pupils. Irregularity of right 
pupils (iris narrow above). Slight mitral valvular sclerosis. Small heart 
(150 grams, but left ventricle 1.5 cm. thick), and small aorta (s cm. in 
circumference). 

Acute Conditions. — Gangrene of posterior portion of right upper lobe 
of lung (culture, streptococcus pyogenes and diphtheroid organisms), with 
acute fibrinous pleuritis, bronchial edema, and swelling of bronchial lymph 
nodes. Septicemia (determined on culture, streptococcus pyogenes and 
diphtheroid organisms). Unusual hirsuteness. 

Nervous System. — Brain weight 1410 grams. Dentate nuclei abnormally 
firm and yellowish. 



142 A STUDY OF DEMENTIA PR.ECOX [July 

Case IV.— D. R, D. S. H., No. 7987. Path. No. 1062. Female, 38, mar- 
ried. Born in Nova Scotia of Irish parentage. Was a case of dementia 
prsecox, paranoid type, of eleven years duration. 

Facts of heredity unknown. 

Previous History. — At the age of 28, about a month before commitment 
to D. S. H., patient had been depressed and suicidal, with delusions that 
she was being killed, had been partially buried, had seen spirits, had had 
two hearts and was immortal. It appeared that the patient had been 
lately deserted by her husband and much over-worked. She had had three 
children, one living. 

Shortly after admission, August 31, 1895, she was given the diagnosis 
of primary delusional insanity. She showed rales in both apices and edema 
of ankles. Patient worked in the laundry. Was occasionally reticent, but 
at other times freely stated her delusions. Tooth-aches and neuralgic pains 
she attributed to external influences. Was at times abusive, noisy and 
obscene. At other times would show no evidence of mental disorder for 
several weeks. In the course of two or three years, physical inertia in- 
creased, delusions could be still elicited, with somewhat less coherent 
explanations. Sample of conversation : " I was referring if you thought 
I felt well and if it was for your purpose to ask these questions. I proved 
it whether I am worthy of my home. There are two police stations and if 
you are acquainted with medical things you will see the church about me." 
Active auditory hallucinations appeared at times. The tuberculosis prob- 
able at admission became definite 10 years later. Patient died after a 
terminal disease of about four months. This patient apparently never 
showed well-defined katatonic signs, unless occasional reticence with physi- 
cians and a single period of mutism can be so interpreted. 
Anatomical Diagnosis (E. E. Southard). 

Cause of Death. — Phthisis pulmonalis. 

Chronic Conditions. — Poor musculature. Malnutrition. Poor teeth. 
Lineas atrophicas of abdominal skin. Chronic obliterative pleuritis (right), 
and extensive adhesions of left pleura. Extensive bilateral tuberculosis 
with cavitation of lungs and bronchitis. Enlargement and induration of 
bronchial lymph nodes (tuberculosis, microscopically). Aortic, common 
iliac, internal iliac (slight), renal (microscopic), and (slight) coronary 
arterioscleroeis. Fatty liver with (microscopically) slight portal cirrhosis. 
Genitalia atrophic. Thyroid small (aberrant thyroid above bifurcation of 
trachea, right anterior, 2x1.5x0.5 cm.). Marrow of right femur red. 

Nervous System. — Brain weight 1260 grams. Gliosis of superior frontal, 
prefrontal and orbital gyri. Brain (except gliotic areas and occipital 
gyri) and spinal cord (especially lumbar) reduced in consistence. Cere- 
bellar cortex darker than cerebral cortex. 

Case V.— M. R., D. S. H., No. 6531, Path. No. 1137. Male, 35, single. 
Shoe-factory operative. Born in Lynn, Mass., of Irish parentage. Was a 
case of dementia praecox, at first paranoid, later at times katatonic, and 
finally demented; of about 15 years total duration. 



I9IO] E. E. SOUTHARD I43 

Heredity of insanity denied. Father possibly alcoholic. A brother died 
of tuberculosis. 

Previous History. — September i, 1891, patient developed a delusion that 
persons in an electric light plant opposite his shop were putting currents 
on him. Insomnia, constipation, lack of appetite, pains in the head and 
confusion of mind followed, and patient was committed to D. S. H., 
October 2, 1891, with exaggerated knee-jerks and little or no physical 
disorder. Apparent dementia increased. Unusual motions and gestures 
could not be explained by patient. At first he worked well in the brush 
shop, but later ceased work, became mute, and sat still in one place, smil- 
ing. The attendant could get patient to walk up and down the ward. 
Limbs were habitually blue and cold. In taking exercise, a certain num- 
ber of steps were always taken and a certain crack in the floor was fol- 
lowed. When seated, the limbs were held fixed and the mouth open. At 
times the patient would sit gesticulating for long periods at a time. Later, 
the gestures and peculiar attitudes ceased, but m.utism persisted. Once, 
in 1903, the patient whispered a few words. There was never any refusal 
of food during the Danvers stay. Death January 19, 1906. 
Anatomical Diagnosis (E. E. Southard). 

Cause of Death. — Phthisis pulmonalis. 

Chronic Conditions. — Malnutrition. Chronic adhesive pleuritis of left 
upper lobe and right apex. Mitral valvular sclerosis. Brown atrophy of 
heart muscle. Small heart (170 grams, but left ventricle 1.3 cm. thick) 
and small aorta. Chronic interstitial nephritis. Dilatation of stomach. 
Right testis fibrotic. 

Recent Conditions. — Tuberculous pneumonia of left lung, with acute 
fibrinous pleuritis. Bronchopneumonia of posterior portion of right lung. 
Early enterocolitis (?) with large, soft mesenteric lymph nodes. Acute 
splenitis. Fatty liver and kidney (both slight). 

Nemous System. — Brain weight 1465 grams. Superficial asymmetry in 
minor sulci of cerebrum. Microgyria of right superior parietal lobule (no 
certain evidence of atrophy, but more flaring sulci ; in particular the right 
parieto-occipital fissure is i cm. deeper and much wider than the left). 
Focal chronic fibrous leptomeningitis of right parieto-occipital fissure. 
Consistence of brain diminished (anterior poles least and lower surface 
of cerebellum less than upper surface). 

Chemistry. — The water-content of three portions of the brain was deter- 
mined in the chemical laboratory of the Harvard Medical School by Mr. 
J. B. Ayer, Jr., who found the following percentages : frontal region, 75 
per cent; parietal, 77 per cent; cerebellum 82 per cent water. These find- 
ings parallel the consistence noted with the finger. The anterior poles 
were the least softened. The low percentage of water possibly indicates 
relatively high neuroglia content. 

Case VI.— G. B., D. S. H., Nos. 11641, 3238, Path. No. 1149. Male, 57, 
single, carpenter. Born in Salem, Mass., of American stock. Was a case 
of dementia prsecox, paranoid type, of perhaps 32 years duration. 



144 A STUDY OF DEMENTIA PRECOX [July 

Heredity. — Facts not known. 

Previous History. — Was perhaps not "just right" from boyhood. Had 
certain delusions and may possibly have been suicidal early in life, but was 
shortly transferred after his first stay at Danvers to the Salem Almshouse, 
where he was quiet and industrious. Patient showed insomnia at times 
and had sensations of " sparks of fire " dropping on his head. 

Readmitted January i, 1904, with signs suggesting tuberculosis at both 
apices. A coarse tremor of extended tongue, a moderately fine tremor of 
extended fingers, and markedly exaggerated knee-jerks. Examination by 
Dr. H. W. Mitchell showed that the knee-jerks are usually followed by 
momentary clonus or tonic spasm of the leg followed by general body 
spasm, which does not seem to be always the same. The different move- 
ments depend upon the different postures of the body at the time the knee- 
jerk is obtained. Often the same body spasm can be gotten by a feint to 
strike the quadriceps tendon. Achilles reflex is prompt, but not much in- 
creased. It is followed, however, by various spasms of the legs, the most 
common being a tonic spasm of the muscles of the leg and thigh, often 
accompanied by irregular spasms of muscles of the trunk. Triceps and 
biceps prompt and lively and followed by irregular body spasms. Cre- 
masteric and abdominal slight. Plantar very much increased, followed by 
tonic or clonic leg spasms. Usually no lifting of right toe. Rarely a sug- 
gestion of Babinsky reflex. The only physical stigma consisted in poorly- 
formed lobules. 

Auditory hallucinations had been frequent for many years, always in the 
tones of attendants or other bystanders. There was one episode of visual, 
olfactory and gustatory hallucinations of an unpleasant character. 

Very characteristic were patient's description of peculiar spiritualistic 
phenomena, with " forerunners and communications." Patient would often 
communicate with God, assuming a rigid position, gazing into space, and 
saying, " God, our Heavenly Father, I would like to communicate, if con- 
venient, don't discommode yourself!" He pauses a few moments and then 
says, "Is that you? Is that you really. Heavenly Father? Please come as 
an apparition, as strong as you can." Then in a faint voice, " That's pretty 
good, pretty good. Can you come a little stronger, I wish you would if 
you could ; that pretty good, that's good. God, Heavenly Father, is 
it safe to show the forerunner in the face of Dr. Mitchell? Are you sure, 
perfectly sure? All right." He would then make a peculiar movement of 
the hands which he alleges is a forerunner, and has the power of destroy- 
ing life. Asked to forecast the future, he calls up God as previously, and 
says, " I wish to ask a question in regard to Dr. Mitchell's success in the 
future? Is your time precious, God? Can you spare it?" He turns to 
the examiner and says, " He is gone now to examine. He examines by 
astronomy." In the meantime, patient converses pleasantly about the 
weather until God calls, and later assures examiner that his success is to be 
unlimited, and that he has received communication. Result of these com- 
munications were, as a rule, optimistic. 

Patient made characteristic, elaborative, decorative drawing, ostensibly 



igio] E. E. SOUTHARD 145 

for certain Masonic lodges. In 1905 certain slight mannerisms appeared, 
which later grew more frequent. He would wet his hands frequently, 
repeat certain muscular movements, shake his body, and make peculiar 
noises in his throat. 

The patient died March i, 1907, having been taken the day previously 
with vomiting and severe abdominal pains. 

Anatomical Diagnosis (H. W. Mitchell and F. P. Gay). 

Cause of Death. — Tuberculous enterocolitis with ulceration and perfora- 
tion with localized peritonitis. Bacillus coli communis in heart's blood at 
autopsy. 

Chronic Conditions. — Emaciation. Chronic fibrous pericarditis. Slight 
tricuspid valvular sclerosis. Chronic obliterative pleuritis (left) and chronic 
apical adhesive pleuritis (right). Disseminated tuberculosis of both lungs. 
Caseating mesenteric lymph nodes. Chronic pericholecystitis. Hepatic 
atrophy (especially left half of right lobe and all of left lobe). Chronic 
splenitis (marked). 

Acute Conditions. — See cause of death. Acute nephritis. 

Nervous System. — Brain weight 1490 grams. Generalized cerebral 
sclerosis (without visible atrophy). Occipital lobes firmer than rest of 
brain. Chronic fibrous leptomeningitis, confined to the superior frontal 
gyri. Cerebellum and spinal cord soft. Slight chronic external adhesive 
pachymeningitis. 

Case VH.— R. S., D. S. H., No. 11863, Path. No. 1168. Female, 24, 
single, a weaver by occupation. Born in Canada of French-Canadian par- 
entage. Was a case of dementia praecox, hebephrenic type, of four years 
duration. 

Heredity. — An aunt insane. 

Previous History. — Of normal early development. Four years a weaver 
in Massachusetts. Deserted by lover at 20. Indifference and melancholy, 
auditory hallucinations, delusions of persecution, subjective sensations of 
heat. Occasional attacks of violence and refusal to be dressed followed. 

Upon commitment, April 22, 1904, a slight tremor of tongue, slight 
albuminuria, and semi-adherent lobules were noted. Patient was quiet, 
usually mute, indifferent, occasionally irritable, and resistive. Patient lay 
in bed with clothes pulled over her head and would start up suddenly, 
rocking back and forth. 

There was an apparent amnesia for recent and remote events. Auditory 
hallucinations, ill-defined delusions of persecution, a silly apathetic attitude 
persisted. Mutism developed later. 

About a year after admission, signs of tuberculosis and physical failure 
set in, and 17 months after admission, signs of tuberculosis were detected 
and tubercle bacilli were found. Thereafter patient grew brighter and 
would occasionally sing, but would not talk and had to be tube-fed. The 
knee-jerks, normal on admission, were later lost (September, 1906). 

The patient died May 4, 1907, about 14 months after onset of physical 
failure. 



146 A STUDY OF DEMENTIA PILECOX [July 

Anatomical Diagnosis (E. E. Southard). 

Cause of Death. — Thrombosis of left common iliac vein and vena cava 
(unidentified organisms). 

Chronic Conditions. — Malnutrition. Ascites. Hypertrophic cirrhosis of 
liver (2260 grams). Chronic adhesive pleuritis (both upper lobes). 
Bilateral phthisis pulmonalis. Bronchial lymph node tuberculosis. Brown 
atrophy of heart muscle. Slight mitral valvular sclerosis. Coronary 
arteriosclerosis. Chronic gastritis. Slight enlargement of right lobe of 
thyroid gland. 

Recent Conditions. — See cause of death. Edema of left leg. Fatty 
changes in liver and kidney. Acute perisplenitis (extension from pleural 
process). 

Nerz'ous System. — " Brain weight 1105 grams. The cerebral hemispheres 
show no variety in consistence and suggest a slight softening of post-mortem 
origin. The convolutions are everywhere of the usual richness and ap- 
pearance except that the upper two-thirds of the postcentral gyri appear 
narrower than normal, being scarce two-thirds the width of the precentral 
gyri. It is impossible to make out on section that the underlying white 
matter is firmer in the postcentral than the precentral gyri. The limits 
of this lesion cannot be made out exactly, and the lesion probably repre- 
sents an anomaly of the postcentral gyri. Basal ganglia not remarkable. 
Weight of cerebellum, bulb and pons, 145 grams. The olives have the con- 
sistence of those of a normal brain. The right dentate nucleus is firmer 
than usual. There is a suggestion of thinning out of the laininas in the 
clival and cacuminal regions. 

Middle Ears. — Normal. 

Spinal Cord. — Shows an increase of consistence in the lumbar region, 
and several segments at various points seem to show a thinning out of the 
anterior halves without, however, demonstrable diminution in the area of 
cross-section." 

Case VIII.— J. O., D. S. H., No. 10862, Path. No. 1294. Female, 37, 
married, housewife. Born in Lynn, Mass., of Irish parentage. Was a 
case of mental disease, possibly dementia praecox, paranoid type, of six 
years duration. 

Heredity. — Facts not known. 

Pre^'ious History. — Patient was married at 23 and had four children, 
three girls and a boy. Nineteen days after the birth of the last child, which 
took place normally, except that both legs had been swollen, patient be- 
came noisy, thought she was dying and asked for the priest. She was 
carried to Lynn Hospital and was there excited and had auditory hallu- 
cinations. The left leg had swollen much worse 10 days after birth of 
child. 

Upon commitment to D. S. H. June S, 1902, this leg was still swollen and 
the skin scaling. The patient was confused and suspicious, at first tractable, 
later resistant, occasionally listening to imaginary voices, stating " they seem 
to speak from my hand." Delusions were sometimes somatic. When 



I9IO] E. E. SOUTHARD I47 

asked what was the trouble wth her, " It is hke Httle bits of formed chil- 
dren. It makes me nervous." Pointing to the physician's note-book, she 
said, " That is not saints' work." Periods of violence with biting, kicking 
and scratching would alternate with quiet and agreeable periods. Food was 
refused. Ten days later the patient had become somewhat better and 
developed some insight, and about a month after admission was apparently 
recovered from hallucinations. Removed upon a visit by her husband, the 
patient again became depressed, apprehensive and confused. Heard " rap- 
pings " at night. Patient stated, " These things I am telling you are all 
lies, but I have got to say them, because I have that feeling and cannot 
explain. I feel as though someone was compelling me to go through with 
it. This person has a grudge against me." There was considerable varia- 
tion in the development of hallucinations. Patient spoke of queer doings 
going on at the hospital and talked about seeing " four generations " walk- 
ing out of the dining-room. Exceedingly active hallucinations developed 
again in November, 1902, and patient broke glass to reach her husband, 
who was being crucified. Patient became resistive, violent, profane; would 
then relapse into depression and confusion. Food was refused as unneces- 
sary. In February, 1903, patient had become dull, would talk little, was 
occasionally resistive. 

March 9, 1903. said, " When the sandbags came on the ward for the old 
lady with the fracture, the Lord said even the sandbag liked her because 
she had sandbags at the Lynn Hospital, and she used to go to the beaches 
too." Occasionally talked in a grandiose way about being St. Johanna. 
Occasionally struck patients without provocation, and would frequently 
run the length of the ward for no apparent reason. Patient often spoke of 
herself in the third person and often knelt in an attitude of prayer. While 
walking attempted to touch every tree. Patient began to refuse to dress 
and take care of her room. Conversation became loose and contained many 
meaningless phrases: ''Why did you come here? You hear me and you 
know my reports as a queen. Yes, I am the queen of England. I was 
known as Mrs. Page in the hospital. The carriages and horses are all in 
my name. Do you deny it, Johnnie? Who do you mean? Nothing new. 
I have all my money invested. I have my own rights and places up there." 

In 1907 the patient was transferred to the tuberculosis ward and there 
died December 14, 1908. Toward the close of life, knee-jerks had been 
exaggerated. There was apparent amnesia, and only partial orientation 
could be demonstrated. 

Anatomical Diagnosis (A. H. Peabody and M. M. Canavan). 

Cause of Death. — Phthisis pulmonalis and tuberculous enteritis with 
ulceration. 

Chronic Conditions. — Malnutrition. Slight ascites, hydrothorax, and 
edema of ankles. Hydropericardium. Slight chronic fibrous endocarditis. 
Chronic obliterative pleuritis (right). Chronic apical pleuritis (left). 
Ovarian atrophy. Erosion of cervix. Tuberculous ulceraton of colon. 
Enlarged lymph nodes near cecum and along aorta. Cavitation of left 



148 A STUDY OF DEMENTIA PRECOX [July 

Upper lobe. Disseminated tuberculosis of right lung. Enlarged bronchial 
lymph nodes. Calvarium dense. Slight chronic e.xternal adhesive pachy- 
meningitis. 

Acute Conditions. — Acute nephritis. 

Nervous System. — Slight chronic leptomeningitis with adhesions at 
frontal and temporal tips. Brain weight 1120 grams. Generalized increase 
of consistence of cerebrum (especially frontal and occipital), pons, and 
cerebellum. 

Case IX. — J. W., D. S. H., No. 14591, Path. No. 1298. Female, 36, mar- 
ried, housewife. Born in Dracut, Mass., of Irish parentage. Was a case 
of dementia prsecox, katatonic type, of about nine months duration. 

Heredity. — -Negative. One brother and one sister died of tuberculosis. 

Preznous History. — -Healthy as a child. A good student, disposed to 
quick temper. Married at 25. Miscarriage at five months, followed by 
three boys and a girl. Became nervous and run down at 34 years. 

Present Illness. — Onset of pain in right side about April i, 1908. Several 
weeks later patient dropped her work complaining of " physical incapacity 
and pain in the chest." Insomnia and brooding followed and in June patient 
complained of having tuberculosis, but said she could not get well. After 
a vacation she began in August to worry more. She was once disposed to 
jump out of a window and several times stated that relatives were trying 
to cut her up. She feared poison in her food. There were spells of loose- 
ness of bowels followed by constipation. 

Patient was committed to D. S. H. October 6, 1908. Partially adherent 
lobules of ears. Slight hypertrichosis of upper lip. Gothic palate. Teeth 
in poor condition. Atrophy of breasts. Expansion of right lung less than 
that of right. Slight resistance of passive movements. Upon admission 
patient chiefly lay in bed as a rule with her eyes full of tears, moved very 
slowly and expressed the idea that every one was trying to hurt her. 
Patient's emotional reactions were very slight, although stating that deep 
palpation of the abdomen hurt her. Her expression gave no signs of pain. 
Although describing fear of being hurt, she gave no further evidence of fear. 
At first appeared depressed and retarded, she later improved. Had a spell 
of untidiness, became more active, gave irrelevant' replies, and showed 
inertia suggesting dementia praecox. The diagnosis of manic depressive 
insanity, depressed phase, was first made, largely based on retardation in 
conversation and movements. In the middle of December, 1908, patient 
again became untidy and sat on floor ; showed certain physical failure. 
Her conversation was limited largely to " I want to go home." Without 
definite proof of tuberculosis, she was placed in the building for tubercu- 
losis, and there showed restlessness, negativism, a tendency to pulling bed 
clothes from other patients and untidiness. There were several slight rises 
of temperature. January 7, 1909, patient had a severe generalized convulsion, 
after which time she lost weight, became unable to speak and to swal- 
low easily. She mentioned slight headache in the last few days of her life. 
Death January 16, 1909. 



I9IO] E. E. SOUTHARD I49 

Anatomical Diagnosis (M. M. Canavan and C. G. McGaffin.) 

Cause of Death. — Ileocolitis with ileac ulceration. Infection of cerebro- 
spinal fluid with organism resembling bacillus of fowl-cholera. 

Chronic Conditions. — Malnutrition. Sacral and trochanteric decubitus. 
Teeth poor. Gastroptosis. Chronic perisplenitis. Chronic periappendicitis. 
Chronic adhesive apical pleuritis. Slight chronic parietal endocarditis. 
Mitral valvular sclerosis. Small vegetation of aortic valve. Slight aortic 
sclerosis. Tuberculosis of apices. Slight cirrhosis of liver with fatty 
change. Chronic purulent cholecystitis. Laceration of cervix. Chronic 
external adhesive pachymeningitis over vortex. 

Acute Conditions. — Tumor of left kidney. Acute nephritis (pyelo neph- 
ritis?). Acute endocervicitis. Thrombus of left internal iliac artery. Uulcers 
of ileum. Injection of jejunum, ileum, colon and rectum. 

Nervous System. — Pia faintly injected and adherent to dura over left 
middle frontal in an area i x i cm. in diameter, 16 cm. from tip of pole. 
Pia is raised from the brain by a clear fluid over the vertex region. Pia 
slightly cloudy over vessels, but strips from cortex smoothly. Hemispheres 
equal in size and in general slightly firmer than normal. The left second 
temporal convolution is more prominent than others of its side or the oppo- 
site temporal convolutions. The left precentral gyrus measures on mesial 
aspect 2 cm., left postcentral 1.5 cm. The right precentral measures on 
mesial aspect 5 cm. ; the right postcentral i cm. Sulci around right post- 
centra! gaping. Cut sections show the postcentrals to have faint and thin 
grey matter and their white matter shrinks from the knife. The ventricles 
are smooth. Ganglia normal. Basal vessels not notable. Sections of the 
brain show no further gross lesions. 

Brain weight 1300 grams. Pons and cerebellum 190 grams. 

Middle Ears. — Gasserian ganglia and cord not notable. 

Case X.— M. M., D. S. H., Nos. 2874, 11624, Path. No. 1303. Female, 
single, 55, compositor. Born in Peabody, Mass., of American parentage. 
Was a case of dementia prreco.x, observed in a terminal stage. 

Heredity. — An uncle insane at D. S. H. 

Previous History. — Patient was admitted to D. S. H. with diagnosis of 
chronic mania (duration six months) June 6, 1883, and was discharged 
unimproved to Salem Almshouse August 28, 1885. At 29 believed she was 
a clairvoyant ; apparently had auditory hallucinations. Complained of pains 
in throat and constantly spitting blood. " Could feel other people's in- 
juries." Excitement on admission; assumption of absurd attitudes and 
declamation. Disconnection on talk. Made mysterious mention of Masonic 
signs. More active delusions brought out by menstruation. Her delusions 
dealt chiefly with injuries brought upon others which she could feel. At 
Salem Almshouse the dementia advanced. She had a vagrant tendency 
and was resistive. 

Upon second admission to D. S. H. January 4, 1904, patient showed a 
heavy growth of hair on chin and upper lip ; a narrow high palate and 
slight arcus senilis. Exaggerated knee-jerks, continuous tremor of lips, 
II 



150 A STUDY OF DEMENTIA PRECOX [Ju'v 

slight lingual tremor, inconstant tremor of hands, slight peripheral arterio- 
sclerosis, and signs of aortic valve sclerosis. Mentally, patient talked discon- 
nectedly in answer to questions. Failed to occupy herself in any way ; 
wore an unchanging facial expression. Claimed to have been dead and 
reborn many times. Persistently stated that she bore another name than 
her own and showed an apparent defect of memory for both recent and 
remote impressions. Was unable to make her way about the ward. Sample 
of conversation : " We don't know whether it is Heaven or earth we are 
sitting in. The house feels such a move. It moved right along this morn- 
ing like a train. You were marked when you came in." Do you hear 
voices sometimes? "I hear the occupants of another world." Do you 
have any thoughts? "When I read books." Do you read books? " Some- 
times. I believe I am a baby with all these attacks." What attacks? "The 
attacks, points, and scoops." Are you out of your mind? "You have got 
to pray to God to get out of this building. My father told me I would be 
the Lord's wife. He told me to obey my husband and my Lord." How 
long have you been married? "I can't tell, a number of years. I have 
been a baby since I have been married." 

Again, Why were you sent here? "Because I pushed the bed back and 
a bullet came through the wall. I was chewed and born and clambered 
and went through shambles." Why were you sent here? "Because there 
were so many thieves around." What did you do ? "I started my nun 
work and read my Bible in my room, thank God and all God." 

Patient at Middleton Colony restless and vagrant. In last few months 
the patient grew careless of dress and showed mannerisms, stereotyped 
movements, resistiveness and severe Bright's disease. Death February i6, 
1909. 

Anatomical Diagnosis (A. H. Peabody and C. G. McGaffin). 

Cause of Death. — Chronic diffuse nephritis and acute bronchitis. 

Chronic Conditions. — Malnutrition. Slight sacral decubitus. Aortic 
valvular sclerosis (foci of calcification). Slight aortic sclerosis. Coronary 
arteriosclerosis. Dilated stomach. Chronic diffuse nephritis. Chronic 
perisplenitis. Mural and subperitoneal fibromyomata of uterus. Atrophy 
of ovaries. Calvarium dense. Exostosis of frontal bone. Adherent dura. 
Chronic tympanitis auns. Calcification in falx cerebri. 

Acute Conditions. — Acute bronchitis. Slight enlargement of mesenteric 
lymph nodes. Abrasions of forehead and left hand. 

Nervous System. — Brain weight 1220 grams. Chronic fibrous lepto- 
meningitis of vertex, along sulci at base of brain and over cerebellar cis- 
terna. Generalized increase of consistence of brain. Pigmentation of 
cerebral grey matter. 

Case XL— E. F., D. S. H., No. 13582, Path. No. 1310. Female, 28, 
single, mill operative. Born at Manchester, N. H., of Scotch-Irish parent- 
age. Was a case of dementia prsecox probably of hebephrenic tj'pe, pos- 
sibly, originally imbecile. The total duration of the dementia praecox 
features was perhaps four years. 



ipiO] E. E. SOUTHARD I5I 

Heredity. — Facts unknown. Insanity in family denied. 

Previous History — Patient always of subnormal mental capacity. " Pecu- 
liar, stupid, and ugly." Dull and backward at school. Worked steadily 
in a mill, but never saved money. Was sullen and cranky. At 24 years 
irritability, indolence, untidiness, aimless wandering and increasing silliness 
set in. A tendency to gluttony. The police often picked her up on the 
street at night. 

Patient was admitted to D. S. H. April S, 1907. Adherent ear lobules. 
High arching palate. Acne eruption. Gait peculiar, at times normal, at 
times patient swings one foot in front of the other and totters back and 
forth (mannerism?). Occasionally turns and twists her fingers about in 
a stereotyped way, touching objects with finger tips. Knee-jerks exag- 
gerated. Patient smiled and grinned, was untidy, and habitually lay in 
bed with clothes over her head. Patient mute except on repeated ques- 
tioning, when an occasional " yes " or " no " could be elicited. Later patient 
became more tidy and again untidy. Patient was apparently not oriented 
while in hospital and showed amnesia and defective impressibility. 

Developing fever in November, 1908, she was transferred to the tubercu- 
losis building, where she grew weaker and died March 22, 1909. 

Anatomical Diagnosis (C. G. McGaf5n and N. B. Burns). 

Cause of Death. — Phthisis pulmonalis. 

Chronic Conditions. — Malnutrition. Unequal pupils. Asymmetry of 
thorax. Marked mitral sclerosis. Hypertrophy of left ventricle. Hydro- 
pericardium. Chronic adhesive pleuritis of anterior portion of left lung. 
Tuberculosis, with cavitation of left lung, and slightly of right lung. En- 
larged bronchial lymph nodes. Chronic passive congestion of liver. Dex- 
troflexion of uterus. Thyroid gland small. Cyst of left Fallopian tube. 

Acute Conditions. — Thrombosis of left auricle, staphylococcus septicemia. 

Nervous System. — Gliosis of both frontal regions. Atrophy (or aplasia?) 
of left postcentral gyrus. Left precentral gj'rus broader than right. Brain 
weight 1300 grams. 

Case XH.— 1M. C, D. S. H., No. 12143, Path. No. 1317. Female, 44, 
single, mill operative. Born in Ireland : father English, mother Irish. Was 
a case of dementia prsecox of paranoid type of 21 years standing. 

Heredity. — Father intemperate. 

Previous History. — Patient a woman of ordinary mental capacity. Lim- 
ited education ; of melancholy and reserved tendency. Attack began at 23 
with insomnia and anorexia, followed later by auditory hallucinations, fear, 
desire to become a nun, and wandering tendency. 

On admission to D. S. H., October 25, 1897, the diagnosis of primary 
dementia was made. Patient was resistive, repeating, " Oh, my God pro- 
tect me." Had auditory hallucinations and various delusions, sometimes 
religious. Mutism, refused to eat, restlessness, later increased stupidity, 
untidiness, and troublesome activity. In 1890 patient was able to work in 
the 'laundry, but in 1893 became quarrelsome and violent, often laughed in 



152 A STUDY OF DEMENTIA PRiECOX [JuIy 

meaningless fashion and could not be prevailed upon to answer questions. 
Removed to Lawrence Almshouse June, 1893. 

Recommitted to D. S. H. August 31, 1904. Patient sat about idly talk- 
ing to herself or laughing in a silly manner and if permitted would wear 
four or tivc aprons. Her speech was peculiar and babyish and many re- 
plies were in whispers. Disorientation was apparently complete. Memory 
for recent and remote events was poorly preserved. Grimaces and various 
mannerisms. Patient would for long periods sit about listlessly and then 
become talkative. At times patient became quarrelsome; noisy at night and 
resistive. 

Cancer of left breast was noted in July, 1908. Operation November 30, 

1908. Had no effect on mental state. Death from metastases May 19. 
1909. 

Anatomical Diagnosis (A. H. Peabody and M. M. Canavan). 

Cause of Death. — Multiple metastatic carcinomatosis. 

Chronic Conditions. — Inequality of pupils. Edema of ankles. Brown 
atrophy heart muscle. Slight coronary arteriosclerosis. Chronic peri- 
appendicitis. Chronic adhesive pleuritis. Lateral misplacement of uterus. 
Chronic gastritis. Surgical removal of left breast (carcinoma). Carci- 
noma of axillary lymph nodes, left lungs, bronchial lymph nodes, and liver. 

Acute Conditions. — Icterus. Hemorrhagic conjunctivitis. Hemorrhagic 
endometritis. Acute nephritis. Hypostatic pneumonia. 

Nervous System. — Adherent dura. Chronic fibrous leptomeningitis, along 
sulci. Cervical spinal cord firm. Brain weight 1210 grams. 

Case XIII.— M. K., D. S, H., No. 14597, Path. No. 1319. Female, 31, 
married, mill operative. Born in Ireland. Was a case of dementia prascox 
of the paranoid type (possibly imbecile) of eight years duration. 

Heredity. — Sister epileptic. 

Previous History. — Poor scholar and truant in convent school in Ireland. 
House work and mill work after coming to America at 15. Married at 18; 
three children, followed by separation. Illegitimate child at 23. An at- 
tempt at suicide is asserted at 23-24. History before commitment is 
limited. Insomnia and street-walking are reported. 

Commitment to D. S. H. October 10, 1908. Slight coarse tremor of 
fingers and tongue. Patient dull and apathetic. Lay quietly in bed look- 
ing at one point on ceiling as if hallucinated. Orientation imperfect. 
School knowledge and calculating ability deficient. Memory somewhat im- 
paired for remote events ; still more impaired for recent events. It later 
transpired that she could see the Virgin Mary at any time. Patient at times 
sang religious strains. Muscular movements were in general slow and lan- 
guid. She was apt to assume attitudes suggesting those of saints in religious 
pictures. Once she betrayed a fear that men were after her. In January, 

1909, she had become at times resistive and fearful. She was tube-fed 
several times. At times patient stated that she had a bad taste in her 
mouth. 

Died May 28, 1909, of colitis. 



I9IO] E. E. SOUTHARD I53 

Anatomical Diagnosis (A. H. Peabody and M. M. Canavan). 

Cause of Death. — Acute follicular colitis. 

Chronic Conditions. — Malnutrition. Inequality of pupils. Edema of 
ankles. Ascites. Chronic adhesive pleuritis, left. Chronic fibrous peri- 
carditis. Chronic fibrous endocarditis. Aortic sclerosis. Tuberculosis of 
left apex. Chronic perisplenitis. Renal arteriosclerosis. Chronic diffuse 
nephritis. Slight cirrhosis of liver. Chronic endocervicitis. Calvarium 
dense. 

Acute Conditions. — Acute nephritis. Acute jejunitis, ileitis and colitis. 
Acute proctitis. Acute vaginitis. 

Nervous System. — Cervical spinal cord large. Slight chronic lepto- 
meningitis especially basal. Brain weight 1250 grams. 

Case XIV.— F. O., D. S. H., Nos. 8471, 13648, Path. No. 1335. Male, 32, 
single, shoemaker, born in Lynn, Mass. Father born in Massachusetts ; 
mother born in Nova Scotia. Was a case of dementia praecox, katatonic 
type, of 20 years duration. 

Heredity. — Paternal grandfather alcoholic. 

Previous History. — At 12 years an attack of confusion and more or less 
unconsciousness lasting two weeks. Pains in back and head at intervals 
for years. At 18 years spells of laughter and boisterousness, delusions of 
being mesmerized, elation and depression spells, insomnia, threats of vio- 
lence and suicide. 

On commitment to D. S. H., October 23, 1896, patient was talkative and 
expressed numerous delusions and pseudoscientific theories. " The moon 
is the blind eye of some animal. There is a change every thousand years, 
so. the men of a thousand years ago are now women, and vice versa. The 
reason why the Egyptians are so small is because he put vitriol into them 
a thousand years ago, and it is all described in the inscriptions. He has 
the shoulders of an Egyptian, the head of Napoleon or an Italian, and his 
limbs are French. We are all being continually acted upon by minerals, 
herbs, electricity, and magnetism, and one person's brain acts directly upon 
another's." 

The physical condition was well maintained. There was a progressive 
apathy, with occasional noisy spells and unprovoked assaults on patients. 
In 1898 assigned historic parts to officers : head supervisor was Mrs. 
Grover Cleveland, superintendent was Napoleon, the pathologist was 
Daniel Webster, etc. Much profane, obscene and foolish talk. 

Later, patient was habitually found mumbling and laughing foolishly on 
a settee. Eczema of buttocks and scrotum from dribbling of urine. Dysen- 
tery in September, 1904. The urine then began to show albumin. 

Patient's apathy occasionally gave place to excitement, denudative spells, 
and the expression of extravagant delusions. 

Transferred to Foxboro State Hospital March s> 1907. Readmitted to 
D. S. H. May 10, 1907. Untidy, manneristic, with tendency to hold fixed 
positions. Placed in tuberculosis building in 1908, where he had spells of 
noise-making. Diarrhoea set in in July, 1909, but there was no blood or 



154 A STUDY OF DEMENTIA PR^-ECOX [July 

mucus in the stools. Toward the close, patient could not keep a straight 
line in walking. Patient's characteristic position was similar, lying, stand- 
ing, and walking, and consisted in a curled-up stoop with arms folded 
over abdomen. 

Death suddenly, after a gradual exhaustion, August 21, 1909. 

An.\tomical Diagnosis (M. M. Canavan and A. A. Hornor). 

Cause of Death. — Phthisis pulmonalis. Intestinal obstruction. 

Chronic Conditions. — Malnutrition. Dilatation of pupils, oval from above 
downwards. Scaling and pigmentation of skin. Chronic focal adhesive 
peritonitis. Chronic adhesive apical pleuritis (left). Hydrothorax (right). 
Heart small (145 grams). Slight chronic fibrous endocarditis (left ven- 
tricle). Tuberculosis of apex of left lung. Tuberculosis with cavitation of 
right lung. Liver weight 940 grams. Cystitis and prostatitis. Slightly 
adherent dura. Chronic tympanitis auris (left). 

Acute and Recent Conditions. — Intestinal obstruction. Acute jejunitis 
and ileitis. Mesenteric lymphnoditis. Acute nephritis. 

Nervous System. — Spinal cord small. Chronic leptomeningitis along 
sulci of vertex, in Sylvian fissures, and at base of brain. Thrombi of 
superior longitudinal and left lateral sinuses. 

Case XV.— M. D., D. S. H., Nos. 10098, 10580, Path. No. 1358. Male, 
24, single, shoemaker. Born in New Brunswick of Irish-Canadian parent- 
age. Was a case of dementia prscox, katatonic type, of 10 years duration. 

Heredity. — Unknown. Orphan. 

Previous History. — Two years before commitment, malaria with refusal 
to talk (patient's statement). Normal to 15 years, of average school 
capacity. Ten days before commitment patient had spells of crying, jump- 
ing, shouting, and incoherent talk, with refusal of food for about a week. 
Patient believed he had appendicitis: Urine was drawn with catheter four 
or five days before commitment. Headache during two nights before 
commitment. 

Commitment D. S. H. September 15, 1900. Nose asymmetrical. Mal- 
nutrition. Depression explained by patient as due to lack of sleep, having 
no mother and lack of appetite. Patient was dazed and bewildered, re- 
fused food, was at times normal, later mute, untidy, resistive. The kata- 
tonic symptoms then diminished, and patient could be got to take food. 
Periods of mutism and fixed attitudes alternated with brighter and more 
responsive periods. Late in 1900 he had become apathetic, but worked in 
the dining-room, occasionally noisy and mischievous. Tonsillitis in March, 
1901. Weight and physique had in general much improved. Active symp- 
toms then almost wholly ceased, and patient was discharged April i, 1901. 

After discharge, patient worked well in shoe shop and drove team ac- 
ceptably to employers. On being taken to learn a trade in Boston, August, 
1901, he stayed but two weeks, and returned erratic, boastful, profane, 
threatening, and was recommitted October 12, 1901, in approximately per- 
fect physical health. 

As a rule surly and profane, patient was sometimes tractable (November 



I9IO] E. E. SOUTHARD I55 

1901 ; February to July, 1902; September to Januarj', 1903). Occasionally 
untidy. Often restless, sleepless, and annoying to helpless patients. A 
second attack of follicular tonsillitis September, 1902. 

April, 1904, confusion, peculiar way of putting on clothes, swaggering 
about, mutism or incoherent responses to questions, facial grimaces, twitch- 
ing of facial muscles. November and December, 1904, orderly and tract- 
able, though apathetic, correspondent with an attack somewhat suggestive 
of typhoid fever (positive Widal reaction in second week). 

During 1905 and 1906, patient was apathetic, idle, properly oriented, and 
had very good memory. 

In the spring of 1906 patient grew depressed and unwilling to eat, became 
untidy, mumbling, and disoriented, and during July and August became 
restless, excited, given to running about making peculiar movements and 
assaulting helpless patients. A period of quiet dulness followed. 

Patient's weight increased ; he was given parole privileges. 

In February, 1909, patient grew despondent and untidy, often refused 
food, and took to continual praying. In August dysentery set in, with 
persistent diarrhoea ; mutism and occasional prayers. 

Sudden collapse set in on November 18, 1909. Death. Patient mumbled 
a few words to physician on day of death. 

An.momical Diagnosis (H. M. Adler and M. M. Canavan). 

Cause of Death. — Acute ulcerative ileocolitis (bacillary dysenterj')- 

Chronic Conditions. — Malnutrition. Unequal pupils. Trochanteric de- 
cubitus. Chronic appendicitis. Chronic obliterative pleuritis (right). 
Obsolete tuberculosis of left apex. Chronic perisplenitis. Chronic gas- 
tritis. Cystitis (thickened wall). Calcification of lymph node near pan- 
cfeas. Calvarium thick. Slightly adherent dura mater. 

Acute Conditions. — Acute ileocitis. Enlargement of mesenteric lymph 
nodes. Acute bronchitis (right). Acute splenitis. Fatty changes of liver 
and (slight) kidneys. 

Nervous System. — Sclerosis of left inferior frontal gj-rus. Brain weight 
1200 grams. Slight chronic fibrous leptomeningitis. Lumbar spinal cord 
soft. . 

In seeking for correlations in these data, let us first inquire 
how many of the lesions described can safely or probably be re- 
garded as congenital anomalies or lesions acquired long prior to 
mental change. For a proper judgment here we shall need to 
take into account not merely the lesions in question, but the total 
clinical and anatomical impression presented by each case. 

I, 840. A woman of Irish extraction, a capable school-teacher for 13 
years, developed at 35 after over-work, a depressed, delusive, languid 
state, upon which typical katatonic sj-mptoms shortly supervened, and died 
of phthisis at 37. Possibly the brain was somewhat atrophied, but not 
visibly so, save in the frontal regions. Although visible generalized atrophy 
cannot be asserted, there was a palpable generalized gliosis. {Acquired.) 



156 A STUDY OF DEMENTIA PRECOX [July 

II, 991. A Nova Scotian carpenter, given to frequent masturbation and 
later to excess in venery, developed a mental disease at 24 variously diag- 
nosed in different State hospitals as " hypochondriacal paranoia," " chronic 
melancholia," "neurasthenia," is said to have threatened suicide, com- 
plained of pain, abnormal sensations ("brain and legs whirling round"; 
" I can't speak, because it pulls down and up and wound around me " — 
making motions from abdomen to neck"), was hypochondriacal, eventually 
answered only in monosyllables, developed tuberculosis and died' at 35. 
Slight generalized cerebral gliosis, without visible atrophy. (Acquired.) 

III, 1034. An Italian immigrant, for 10 years a shoe operative of aver- 
age capacity, somewhat easily affected by alcohol, developed at 33 auditory 
hallucinations and persecutory delusions, later grew dull, reticent, given 
to impulsive acts, and then showed echopraxia, cerea flexibilitas, mutism, 
at times automatism; died of pulmonary gangrene at 35. A kind of simian 
hirsuteness and hypoplasia of heart and aorta perhaps suggest " degener- 
acy." The pupils also were unequal and one was oval. The brain of this 
case was of good weight, and the solitary lesion it showed was a sclerosis 
and pigmentation of the dentate nuclei of the cerebellum. (Acquired.) 

IV, 1062. An Irish housewife, who had borne three children, was de- 
serted by her husband and developed at 28 somatic delusions, depression, 
and suicidal tendencies. On commitment signs of tuberculosis of both apices 
were discovered, which tuberculosis was fatal 10 years later. Full of delu- 
sions, abusive, noisy, obscene, the woman never showed katatonic signs 
unless reticence and a single period of mutism can be so interpreted. The 
brain of this case was of proper weight and showed palpable gliosis (with- 
out visible atrophy) of the superior frontal, prefrontal, and orbital gj'ri. 
At death (38 years) the genitalia were already atrophic. There was an 
aberrant thyroid. (Acquired.) 

V, 1137. An Irish shoe operative (father possibly alcoholic) developed 
loose delusions of influence and a little later peculiar motions and gestures, 
mutism, stereotyped movements. All these symptoms, except mutism, 
ceased in later years. The total process lasted 15 years and the man died 
at 35. As in Case II, both heart and aorta were small. One testis was 
atrophied. The brain weighed 1465 grams and showed a striking micro- 
gyria of the right parietal lobule. Whether this lesion is acquired or 
aplastic would be hard to decide on anatomical grounds, but there was a 
focus of chronic pial change in the adjacent parieto-occipital fissure. There 
is a suggestion of sclerotic changes in the frontal regions and the lower 
surface of the cerebellum. (Acquired? Congenital??) 

VI, 1149. A carpenter, hyper-religious, and given to spiritualism, perhaps 
never "just right," has episodes of auditory, visual, olfactory, and gustatory 
hallucination (possibly also tactile), but during a quiet course of 32 years 
eventually settles into habitual, apparently voluntary, " communications " 
with God. Certain tremors, of doubtful interpretation, partly voluntary, 
were at one time evident in reflex tests. Characteristic mannerisms were 



igiO] E. E. SOUTHARD 157 

late in appearing (55 years) and were then slight. Death at 57. The 
brain showed a generalized increase in consistence (without visible 
atrophy) and especially firm occipital regions. There was no palpable 
sclerosis of the frontal regions, but there was a regionary chronic lepto- 
meningitis. (Acquired.) 

VII, 1 168. A French-Canadian woman, of normal development and a 
weaver for four years, after desertion by lover, developed auditory hallu- 
cinations, persecutory delusions, certain subjective sensations, and resistiv- 
ism, later apathy, mutism and less of knee-jerks. Death four years after 
onset, at 24 years. The brain weighed 1105 grams and showed an atrophy 
(or aplasia) of both post-central gyri, a mild sclerosis of the right dentate 
nucleus, and possibly other slight chronic cerebellar lesions. (Acquired, 
Congenital?) 

VIII, 1294. An Irish housewife, who had borne four children, developed 
swelling of both legs at her fourth confinement and 19 days after birth of 
child became boisterous, fearful of death, and had auditory hallucinations — 
thrombosis of left leg had set in. Auditory hallucinations, delusions of 
suspicion, and periods of violence gave place to virtual recovery. At home 
recurrence of hallucinations, followed in the hospital by violence, resistive- 
ness, refusal of food, later apathy. Impulsive movements, frequent genu- 
flexion, employment of third for first person, stereotyped' movements. 
Death after six years at 37. Generalized slight cerebral sclerosis, especially 
frontal and occipital. Slight focal leptomeningitis, frontal poles and tips 
of temporal lobes. Atrophy of ovaries. (Acquired.) 

IX, 1298. An Irish housewife, who had borne four children, developed 
pains, insomnia, ideas of suicide, fear of tuberculosis, delusions of poison- 
ing. On commitment, hypertrichosis of upper lip and atrophy of breasts 
had set in. The palate was Gothic. The symptoms first suggested the de- 
pressed phase of manic-depressive insanity. Apathy, negativism, untidi- 
ness, followed a severe generalized convulsion nine days before death 
(nine weeks after onset, 36 years). Brain of proper weight. Atrophy (or 
aplasia?) of postcentral gyri. Gliosis of left second temporal gyrus. 
(Acquired? Congenital.) 

X, 1303. A woman compositor of New England parentage (uncle in- 
sane) believed at 29 that she was clairvoyant and apparently had auditory 
hallucinations as well as somatopsychic delusions, possibly based on hallu- 
cinations. Apathy, peculiar autopsychic delusions toward death, careless- 
ness in dress, mannerisms, stereotypy, resistiveness. Course of 25 years. 
Death at 55. Generalized increase of consistence of brain, with pigmenta- 
tion and a chronic leptomeningitis of the vertex, along sulci, at the base, 
and over cisterna cerebellaris. (Acquired.) 

XI, 1310. A Scotch-Irish mill-w-orker, a woman always of subnormal 
mental capacity, developed at 24 a pronounced change of character with 
hebephrenic features. In hospital mannerisms or peculiarities of gait, 
certain mannerisms of finger movements, and virtual mutism. Unequal 



IS8 A STUDY OF DEMENTIA PRECOX [July 

pupils. High palate. Asymmetry of thorax. Death at 28. Small thyroid 
gland. Frontal lobe gliosis. Atrophy or (aplasia?) of left postcentral 
gyrus. (Acquired, conegnital?) 

XII, 1317. Woman, mill-worker (father alcoholic), at 23 had insomnia, 
followed by auditory hallucinations, fear, religiosity, vagrancy. In hos- 
pital, resistive, hallucinated, delusive, mute, refusing to eat; later violence. 
Finally apathy, with manneristic speech and grimaces. Death from car- 
cinomatosis, 21 years after onset. Occipital microgjTia. Chronic lepto- 
meningitis along sulci. Cervical spinal cord firm. (Acquired.) 

XIII, 1319. High-grade imbecile. Irish mill operative. Sister epileptic. 
Mother of three children and a fourth illegitimate. One attempt at suicide. 
Eight years' course with onset at 23. Religiosity. Could see Virgin Mary 
at any time (hallucination rather than delusion). Imitation of saints' 
attitudes as seen in pictures. Possibly gustatory hallucinations. Death at 
31. Unequal pupils. Cervical spinal cord unusually large. Slight lepto- 
meningitis, especially basal. (Acquired and congenital.) 

XIV, 1335. Shoe operative. Attack of doubtful character at 12 years. 
Paranoid symptoms began at 18. Katatonic symptoms gradually sup- 
planted the paranoid. Death at 32. Spinal cord unusually small. Brain 
weighed 985 grams, but was apparently not to any great degree atrophied. 
Heart (145 grams) and liver (945 grams) also small. (Congenital.) 

XV, 1358. Irish-Canadian, shoe operative. Onset at 15. Katatonic, 
later apathetic, then apparently recovered (seven months after onset). 
Recurrence four months later. Remarkably periodic course. Death at 
24. Palpable sclerosis of the left inferior frontal gyrus. Slight chronic 
fibrous leptomeningitis. (Acquired.) 

One's superficial judgment, therefore, concerning- the origin of 
the lesions in question is that they took rise in the adult brain in 
840, 991, 1034, 1062, 1 149, 1 168 (at least in part), 1294, 1303, 
1310 (at least in part), 1317, 1319 (in part), 1358=12 cases, 
possibly also in 1137, I298 = maximum of 14 cases. So far as 
1335 is concerned (Case XIV), it might well be doubted whether 
the hypoplastic nervous system formed more than a nidus for the 
mental process ; perhaps this case should be put in the macro- 
scopically normal group. 

It is but fair to insist, on the other hand, upon the congenital 
features. Besides 1335, 1137, 1168, 1298, 1310, 1319, gave rise 
to a suspicion of congenital features in the nervous system alone 
= 6 cases. And, if we add anatomical features outside the 
nervous system, then 1034 (hirsuteness, hypoplasia of heart and 
aorta) 1062 (aberrant thyroid) might be added = a maximum of 
eight cases probably or possibly in part provided with congenital 
features. 



I 



I9IO] 



E. E. SOUTHARD 



159 



It appears, accordingly, that, although congenital features are 
not absent from our group, there is strong color for the pro- 
visional judgment that numerous acquired lesions of the nervous 
system exist in our series. 




Focal Atrophies, Aplasias, or Scleroses in Dementia Precox. 
() indicate microscopic evidence only. 



The Pre-Rolandic Group. 
The frontal region was specially marked out for injury (whether 
acquired or congenital is for the moment not considered) in cases 
840, 1062 and 1358; was prominently injured also in 1294 and 
13 10; and obviously shared to some degree in the generalized 
mild injury which was macroscopically made out in 991, 1135, 
1303, and in 1335 (unless this brain be regarded as showing 
hypoplasia of congenital origin), i. e., in at most nine cases. 



l60 A STUDY OF DEMENTIA PRECOX [July 

Consider first the three cases in which the macroscopic lesions 
specially affected the frontal region. 840 was at first paranoid, 
then shortly katatonic. 1062 was paranoid, perhaps never kata- 
tonic. 1358 was a katatonic case with remarkable remissions. 
At first sight it seems hopeless to seek clinical correlations in 
these cases. But, bearing in mind the conclusions of Campbell 
and Brodmann concerning the histological differentiation of the 
so-called frontal region into subdivisions, it is clear that we can- 
not demand close clinical correlations here. 

As a matter of fact, the lesions of 840 (the case with paranoid- 
katatonic course) involved, so far as eye and finger could de- 
termine, the whole of both frontal regions, and the whole brain 
itself showed a generalized increase of consistence. Whatever 
the relation of the patient's brain disease to her symptoms, there is 
not the slightest doubt that the patient had been subject to a 
sclerosing brain disease of mild but generalized character during 
the last years before death (assigned duration three years). 
Microscopically, the gliosis of this case was generalized and not 
demonstrably severer in the infrastellate layers. 

But, though the changes of 840 are too severe and wide-spread 
and the symptoms too mixed for correlation, the same is not true 
of 1062 (paranoid, perhaps never katatonic). A woman of the 
same age as 840, but with a much longer assigned duration of 
symptoms (11 years or more) and with alcoholism clouding the 
issue, 1062 had maintained proper brain weight and showed 
gliosis confined (so far as macroscopic examination could de- 
termine) to the superior frontal, prefrontal, and orbital gyri, i. e., 
to a continuous area probably containing but two histologically 
separate cortex-types. It is perfectly true that microscopic ex- 
amination shows a degree of the same process (gliosis, satellitosis) 
in other regions, so that here again the brain cannot be freed 
from the suspicion of a generalized change. Still both macro- 
scopic and microscopic examinations seem to prove that the 
superior frontal and prefontal cortex is subject to the most severe 
and possibly to the oldest process of injury. It becomes, there- 
fore, at least a working hypothesis for this case to consider the 
paranoid symptoms as related with lesions in the superior frontal 
and prefrontal regions. 

But what kind of interpretation is left open for the purely kata- 



igiO] E. E. SOUTHARD l6l 

tonic case, 1358? The analysis of this case is still far from com- 
plete. The greater part of both frontal regions was, as a matter 
of fact, wholly spared from macroscopic lesion. Only the left in- 
ferior frontal gyrus was affected, presenting an induration of an 
isolated and distinct, though mild, character in the midst of an 
otherwise apparently normal brain (slight general leptomeningi- 
tis). AVliat relation, if any, this particular lesion bears to the 
katatonia of this (clinically somewhat unusual) case, is impossi- 
ble to say; but it is certain that the data of 1358 do not controvert 
in any respect the correlations suspected for 1062 (the practically 
pure paranoid case) or even for 840 (a clinically more rapidly 
progressive and mixed case), as the macroscopic distribution of 
the lesions indicates. 

The other frontal lobe cases deserve brief mention. The dis- 
tribution of the lesions in 1294 is in consonance with the pro- 
gressive paranoid-to-katatonic character of the disease: the case 
resembles in some respects 840 (just considered) ; but its dura- 
tion is longer (six years) and the katatonic symptoms were much 
delayed in their development. The brain had undergone a mild 
generalized sclerotic process (widely distributed gliosis micro- 
scopically) which had especially affected the frontal and occipital 
parts of the brain and included the cerebellar cortex and even the 
pons. The frontal tips actually showed a few pial adhesions (a 
rare event outside of general paresis and other exudative or post- 
exudative lesions). The extent of this prefrontal process again 
recalls 840; but the whole case is obviously too complex, pro- 
gressive, and longstanding to permit more than a suspicion of the 
course of cortical events. 

1 3 10 is best considered below among complications of the post- 
Rolandic group: it showed both delusions and katatonic symp- 
toms, but was at first pronouncedly hebephrenic. 

The group of generalized glioses (without defined gross 
atrophy) here considered numbers three. One of these (991) 
was practically paranoidal throughout its ii-year course, and, as 
a matter of fact, microscopically showed a marked superior frontal 
lobe gliosis (with satellitosis) ; but the case is clinically not too 
clear, and no deductions need be risked therefrom. 

Another generalized gliosis, 1303, was apparently the end- 
stage of a hebephrenic, with a disease of 25 years' duration. Cor- 



l62 A STUDY OF DEMENTIA PRECOX [July 

relations are impossible. Histologically, there were marked 
gliosis and satellitosis, especially of deeper layers. 

1335' the last of this group, is very possibly an instance of 
hypoplasia or of arrested development of the brain. The brain at 
autopsy weighed but 985 grams (heart 140 grams, liver 940 
grams). Correlations here also are difficult. 

Before dismissing the pre-Rolandic group, 11 49 may be con- 
sidered in this connection. I have placed 1149 provisionally in 
the post-Rolandic group largely on the basis of the well-defined 
occipital gliosis; but the brain showed a generalized sclerosis 
(microscopically marked, with some degree of satellitosis in 
places). The reason for possibly including it, more especially, in 
the frontal group is the occurrence of chronic fibrous lepro- 
meningitis, confined to the superior frontal gyri. The case was 
clinically a supreme example of a paranoid dementia praecox of 
32 or more years' duration, and with certain katatonic symptoms 
appearing verj^ late in life. 

The above sketch of the features of the pre-Rolandic group 
leaves us with the suspicion that paranoid cases begin with lesions 
striking especially the frontal tips and the superior frontal gyri. 
Cases with katatonia supervening later and with a progressive 
course of greater duration show involvement of other regions or 
even of the whole brain. 

The Post-Rolandic Group. 

(a) Cases 1137, 1168, 1298 and 1310 (also frontal) form a 
sub-group which might, perhaps, be termed sensory-perceptual, 
(b) Cases 1149 and 1317 are cases of occipital lesion, 1319 of 
superior temporal lesion. 

(a) The postcentral-superior-parietal or sensory-perceptual 
group of cases claim attention as exhibiting lesions in a region 
doubtless of great importance in interpretation of sensory im- 
pulses. All four of the cases were alike in developing katatonic 
symptoms. 

1 137 began, it is true, with a delusion, but a peculiar one (elec- 
trification) , possibly due to sensory misinterpretation : thereafter 
the patient developed katatonia, demented seriously, and died (15 
years' duration). The visible atrophy (or aplasia) in the right 
superior parietal region, accompanied by microgyria and a dense 



I9IO] E. E. SOUTHARD 163 

local deposit of fibrous tissue, formed a striking local lesion. At 
the time of death, however, gliotic changes with satellitosis had 
become widespread. Purposely I avoid discussing whether the 
focal lesion is acquired or congenital and what its pathogenesis 
may be, since for the time being the topographic distribution of 
such lesions is the important consideration. 

1 168 showed at autopsy what looked like a bilateral anomaly — 
a hypoplasia of both postcentral gyri in their upper two-thirds. 
The onset in this woman occurred at 20 after desertion, and kata- 
tonic symptoms were admixed with persecutory delusions and 
subjective heat-sensations almost at the start. The course was 
katatonic thereafter. 

1298 pursued an acute course of katatonic character with death 
after nine months. The brain showed, besides double postcentral 
gliosis in the white m.atter and visible atrophy of the right post- 
central gyrus, a peculiar focus of duropial adhesions over the left 
middle frontal gyrus. This case was at one time diagnosed as 
depressed phase of manic-depressive insanity. 

1 3 10 appears clinically to show a marked imbecilic strain. Per- 
haps the left postcentral atrophy and the precentral inequalities 
are largely of congenital derivation. The frontal gliosis is con- 
sistent with the imbecilic or hebephrenic cast of the case. Nu- 
merous katatonic features developed. 

The sensory-perceptual sub-group, as represented by these cases, 
shows lesions which lead to the suspicion, if not the proof, of 
congenital anomalies. Symptomatically these cases have kata- 
tonic symptoms in common. 

Post-Rolandic group (b). 1149 and 1317, as well as 1294 
(discussed with the pre-Rolandic cases), belong to an occipital 
group. 

1 149 was briefly mentioned in the frontal connection above, 
because the prominence of the frontal region (which could not be 
differentiated on palpation from the remainder of the sclerotic 
brain) was emphasized by a local frontal leptomeningitis. In 
point of fact the occipital regions were more markedly sclerotic 
than the rest of the brain. The case might be asserted to present 
a beautiful instance of anatomoclinical correlation, were we to 
insist on the relation between the occipital gliosis and the well- 
defined, constantly recurring, voluntarily executed visual episodes 



164 A STUDY OF DEMENTIA PRvECOX [July 

("communications with God"). Obviously, such a superfine 
correlation would mean running a good horse too hard. Those 
" communications " must have involved numerous cortical events 
outside the occipital region. It seems safe to maintain, however, 
that, granting some agency exerting a mildly destructive or irrita- 
tive effect upon the occipital region, a useless mental habit like 
these " communications " would probably assume a visual color- 
ing. The existence of disease in a given brain-region may well 
be conceived to determine the course of events in the intact re- 
mainder. The histological examination of this case is incomplete, 
but I conclude from available sections that the calcarine cortex- 
type is relatively intact, whereas the common occipital cortex-type 
exhibits much more marked gliosis and satellitosis. In this early 
phase of our problem, it seems best to rely upon coarse and well- 
defined qualitative distinctions rather than the cell-enumerations 
which later work will demand. I judge from recent comments on 
cortex-architecture that the occipitocalcarine relations will be the 
most vulnerable point of attack in this direction. 

1294, which has been discussed above, also exhibited similar 
histologically demonstrable variations in the intensity of lesions 
in the calcarine and occipital regions (common occipital type 
more markedly affected in the infrastellate layers). As a matter 
of fact, however, in 1294 the hallucinations shown were auditory 
rather than visual (though the patient once broke glass to reach 
her husband being crucified). The brain showed frontal, cere- 
bellar, and pontine gliosis, in addition to the occipital. No tem- 
poral gliosis was made out macroscopically, but there were foci of 
leptomeningitis, both at temporal and at frontal tips. 

1317 again breaks down in anatomoclinical correlation much as 
does 1294, since, despite the occipital microgyria, the hallucina- 
tions, so far as was made out clinically, were auditory. There 
were some religious delusions. 

With respect to relative developments of paranoidal and kata- 
tonic features in this occipital sub-group, it has been pointed out 
that 1 149 was a classical paranoid case with a few katatonic symp- 
toms toward the close of life (32 years' duration). 1317 was 
more doubtful but probably can be interpreted as mainly para- 
noidal ; katatonic symptoms developed late in a course of 21 years. 
1294 was paranoidal. 



igiO] E. E. SOUTHARD 165 

If we compare the sensory-perceptual group (a) cases 1137, 
1 168, 1298 and 1310 with the occipital group (b) 1149, 1317 
(1294), we cannot but be struck with the predominantly kata- 
tonic character of group (a). The physiological correlations be- 
tween katatonic symptoms and the sensory-perceptual field are 
briefly mentioned in Chapter V. 

Infra-Sylvian Group. 

I have provisionally placed but one case, 13 19, in this group, 
a paranoidal case, probably upon an imbecilic basis. There are 
no striking anatomoclinical correlations in the case. This group 
will undoubtedly grow with further experience. 1294, e. g., 
showed focal leptomeningitis of the temporal tips. 

Cerebellar Group. 

It is noteworthy that the cases which we procure at autopsy in 
dementia praecox are provided as a rule with multiple lesions. 
This is particularly true in the advanced cases, where interpre- 
tation may be difficult by reason of the fact that gliosis has over- 
taken the brain as a whole. This difficulty reappears in the 
cerebellar cases. 

1034, however, is a macroscopically pure case of sclerosis of 
the dentate nuclei of the cerebellum. Clinically 1034 was a classi- 
cal example of cerea flexibHitas, in an Italian of 35 years, who be- 
gan with paranoid symptoms (feared anarchists), and in less than 
six weeks became typically katatonic. Microscopic examination 
shows in various areas of the brain a gliosis which had escaped 
palpation in the gross. Some of the areas of intracortical altera- 
tion were undoubtedly far too small to attract attention macro- 
scopically. There was a slight satellitosis of the frontal region. 
The case appeared then, like many other cases of this series, micro- 
scopically not so definite as the data of palpation had indicated. 

1 168 is a case which has been briefly mentioned in the sensory- 
perceptual sub-group of the post-Rolandic cases as showing a 
hypoplasia of both postcentral gyri in their upper two-thirds. In 
addition thereto there was a sclerosis of the olives, of the right 
dentate nucleus of the cerebellum, and of the cacuminal and clival 
portions of the cerebellum. This case was classified as hebe- 
phrenic, but mutism, resistivism, assumption of fixed attitudes and 
12 



l66 A STUDY OF DEMENTIA PRECOX [July 

impulsive rocking movements give rise to the suspicion that kata- 
tonic features cannot be excluded. A congenital element is also 
very possible from both history and brain findings. 

A third case, 1143, showing almost the same findings in the 
brain has been excluded from the group of typical dementia prse- 
cox cases but might be included upon a more liberal interpretation 
of symptoms. 

Other cases would have to be added to this group on the score 
of serious microscopic alterations, which were made out in the 
face of protocols to the effect that the cerebella were macro- 
scopically normal. The group is, therefore, actually much larger 
than the two cases (1034 and 1168) would indicate. 

Provisional Grouping of 14 Cases without Recorded Gross 

Lesions. 

I have analyzed in some detail the cases with recorded minor 
gross lesions and anomalies to the number of 15. There are 
14 outstanding cases having a clear clinical title to the diag- 
nosis of dementia prsecox, but in which no gross lesions were 
recorded. It is of interest to learn what light a microscopic exami- 
nation will throw upon these cases and whether any cases are 
subject to a tentative topographic grouping. 

There are several cases about which there is no doubt that they 
actually belong in the gross lesion group. Thus 1 145 should, per- 
haps have been excluded altogether from this study since the 
protocols were mislaid. Ample block material exists, however, 
which microscopically shows characteristic satellitosis of the deep 
cortex-layers and a marked gliosis of the dentate nuclei (more 
marked left than right). This case might well be placed in Table 
XVII above, as well as in the cerebellar group. 

1145. 10705. F. 37. paranoid. 6y. Brain wt. 1185. 
(Pregnancy at origin.) 

I am sure also that with increasing experience, case 1036 would 
have become an accession to the gross list in the cerebellar group. 
A sketch of this case was presented by the writer in 1907 in his 
study of the granule layer of the cerebellum.^ 1036, 11317, M. 
28, hebephrenic, 6y ; cardiorenal, renal 6 + y; brain Ii75g. 

778, a paranoid case upon an imbecilic basis, I should desire to 
place (with some trepidation) in the superior frontal group. The 



I9IOJ E. E. SOUTHARD 167 

reason for this is that the superior frontal gyri, far more than 
other regions examined, gave evidence of a sclerotic process: con- 
siderable gliosis of the underlying white matter, superficial gliosis 
of rather focal character, and perhaps a slight generalized gliosis 
of the whole gyri, with infrastellate satellitosis. That the process 
was not confined to this region is true, and neuroglia cell mitosis 
was a curious finding in the right precentral gyrus. The para- 
noid features had come on two years before death at 41 in this 
imbecile. Very possibly the case scarcely belongs with dementia 
praecox as usually conceived ; but it seems certain that a similar 
process has begun in the tissues. 

1081, a suicide, can with some confidence be placed in the post- 
central sub-group, if only by the evidence of the stained sections 
which demonstrate a marked inequality in the two postcentral 
gyri. After considerable search, a focus of gliosis and satellitosis 
was found in one of the orbital regions. This case, a good in- 
stance of a hebephrenic with onset at 18 and suicide at 45, shows 
how a minor lesion — anomaly or acquired lesion, it would not be 
safe to say which — can be overlooked at autopsy. Had not the 
postcentral gyri been sectioned in coordinate places and had not 
the orbital gyri been sectioned, this brain might well have passed 
into the " normal " group both macroscopically and micro- 
scopically. 

1208 is a case described by Ayer and the writer in 1908,"' in 
which the gross findings are so altered by the effects of a suicidal 
attempt and by terminal metastatic brain abscesses that a judg- 
ment concerning essential lesions of dementia praecox is difficult. 
The case should perhaps be excluded from the whole series on 
the ground of complications. 

So excluding 1208, we arrive at the judgment that 15 cases in 
which gross lesions were actually described, together with four 
cases in which (in all conscience and with greater experience) 
gross lesions should have been observed, our total of gross lesion 
cases would run to 19 in 28 (the chosen uncomplicated 29 cases 
minus case 1208). This result would mean that gross lesions^ 
focal atrophies and aplasias, and a few focal and diffuse glioses 
without visible atrophy — are found in 68 per cent of a series of 
typical dementia prsecox cases, from which have purposely been 
previously excluded all instances of frank arteriosclerotic and 
coarsely wasting processes. 



l68 A STUDY OF DEMENTIA PRECOX [J"ly 

It seems strange that such a high percentage of visible and 
tangible lesions should have escaped attention, if this Danvers 
series is at all typical of dementia prrecox in general. I am sure 
that in many laboratories the brains of autopsied cases fail to get 
intensive study until after long immersion in formaldehyde solu- 
tion, which obliterates (or by distortion perhaps conceals) minor 
size-differences in gyri. Moreover, anatomists, familiar with sculp- 
ture anomalies of such relatively plastic organs as the liver, kidney 
and spleen, are inclined to dismiss cerebral anomalies of sculpture 
as of the same minor order of interest. Again, the careful palpa- 
tion of the cerebrum and of the cerebellum is not duly practiced in 
all laboratories, nor are blocks for microscopic examination chosen 
on the basis of such intensive inspection and palpation of the brain 
as careful work demands. 

Our own experience has shown how difficult it may be to keep 
one's house in order for intensive work. Eight cases are out- 
standing in which notes of gross lesions are missing. Of these 
eight, four show in certain regions characteristic gliosis and 
satellitosis (891, 944, 977, 1165). The other four (794, 806, 873, 
1006) have so far proved refractory to our efforts to show strati- 
graphic alterations. 

The result is that 24 out of the chosen 28 cases show eithei 
gross and microscopic lesions or microscopic lesions alone, i. e., 
86 per cent. 

V. The Topographic Idea in the Study of Dementia Precox 
AND Allied Conditions. 

The eternal hope of the neuropathologist is the hope of showing 
visible " changes " in the nervous system in the functional psy- 
choses, and not only in them but of them. All insanity, we hear 
on every hand, is really nothing but brain disease, and, if our 
technique were only better, we should be able to point out the par- 
ticular brain-changes which are responsible for insanity. I was 
assured by an enthusiastic psychopathologist that these brain- 
changes are actually so certain to exist that we should not waste 
our time looking for them. 

There are reasons which make this equation : 
Insanity = brain-disease 
really erroneous. In the first place, certain psychiatrists to the 



igio] E. E. SOUTHARD 169 

contrary notwithstanding, modern work has shown that the equa- 
tion should better read 

Insanities = brain-diseases, 
and in the particular form 

Some insanities = brain-diseases 
perhaps we should be inclined to accept at least the spirit of the 
statement. 

Ever since the doctrines of Flourens were overthrown, from the 
days of Hughlings Jackson and Hitzig down to the era of the 
topographers (Campbell and Brodmann, for example), it has been 
known that the brain is a complex of organs. The brain has parts. 
Yet those authors who assert that insanities are diseases of the 
brain are as a rule quite silent as to the hrain-parts involved. The 
brain as an organ of mental disease is for these authors really the 
old Flourens brain, having interchangeable parts like a liver or a 
kidney. 

The only justification for this view of which I am aware is the 
sound idea that the brain, although its parts are not homogeneous 
and interchangeable, still works in a certain integrated, organized 
way. and, when disorder and disorganized workings of brain- 
elements supervene, then mental diseases appear. Thus Wernicke 
supposes that 

insanity = disease of the association elements of the brain. 
This is a definite advance upon older conceptions, at all events 
in clearness. I suppose no one doubts the conceivableness of a 
mental disease based upon such transcortical lesions of association 
fibers as Wernicke supposes. But few would be so bold as to gen- 
eralize the transcortical-injury idea ^ to cover the great bulk of 
mental diseases. 

Even in the field of aphasia, one observes with recent writers 
a tendency to replace the focal-destruction theory with some 
theory more consonant with modern ideas as to the tremendous 
breadth, and complexity of the cortical areas subtending speech. 
From the psychological and logical side comes a vigorous plea 
from Wundt ^ against the fashionable focalizing of the speech 
functions in specified areas. 

Thus a curious situation develops. On the one hand, the topog- 
raphers, both physiological and histological, are demonstrating 



170 A STUDY OF DEMENTIA PRECOX [July 

more and more the extreme delicacy of subdivision which exists 
in the brain-cortex, as elsewhere in the nervous system, so that 
one gains the idea that perhaps no parts of the brain are func- 
tionally interchangeable, save by re-education. On the other hand, 
logicians and critical workers are calling a halt upon the focalizers 
and denying some of the most classical and approved localizations. 
These latter objections are brought with the more force against 
the localization of a complex function like speech, which savors 
of the old faculty-psychology and contains a soupgoji of 
phrenology. 

I believe we should be even more critical concerning the struct- 
ural foundations of mental disease. Suppose we grant that any 
mental symptoms you please, e. g., delusions, hallucinations, neg- 
ativism, cerea ftexibilitas, have a cerebral origin, is it necessary 
to suppose likewise a cerebral disease, as a basis therefor? Yes, 
some would reply, a cerebral disease, but not necessarily struct- 
ural, perhaps functional only. Even the latter escape I should 
be tempted to forbid. 

Consider diabetes mellitus. The glycosuria has in one sense a 
renal origin. But it would be a mistake to consider diabetes 
mellitus a renal disease, structural or functional. I believe that 
the brain permits certain mental symptoms to develop and pur- 
veys these symptoms, much as the kidney of a diabetic permits 
and purveys glycosuria. 

Similar considerations hold with respect to the purveying of 
convulsions by the brain, an account of which I presented in a 
paper on the mechanism of gliosis in epilepsy. Neither a con- 
vulsion nor a katatonic impulsive movement nor the clenched 
fist of a thug is adequately explained by lesions of the muscles 
involved, by lesions of the motor nerves or spinal cord, by activi- 
ties in the precentral gyrus, or even necessarily by any post- 
Rolandic or pre-Rolandic brain mechanism or combination of 
mechanisms. Perhaps, indeed, the reason lodges back of the cen- 
tral nervous system : the convulsion might have been a phenom- 
enon of reflex epilepsy due to intestinal worms, even the katatonic 
movement might conceivably prove a normal and proper reaction 
to some received stimulus, and the thug's brain might have been 
quite " normal " while engaged in permitting asocial acts for 
whose source one should seek far afield. 



I9IO] E. E. SOUTHARD IJl 

On such grounds it has not seemed certain to me that mental 
disease is necessarily brain disease or that, were we able to in- 
spect thoroughly all brain-parts, we should necessarily discover 
" changes " therein in mental disease. Perhaps the thyroid or 
the pituitary glands might induce mental symptoms without in- 
ducing brain " changes," over and above the proper physiological 
changes going on in any brain-part during the execution of its 
normal function. We might be forced to look into the thyroid 
for the cause of some mental diseases, just as into the pancreas 
for that of a diabetes mellitus. 

A priori, therefore, it has not seemed to me at all necessary 
that diseases like manic-depressive insanity or dementia prjecox 
(to use Kraepelin's nomenclature) should exhibit, even theoreti- 
cally, brain-changes. One was especially disposed not to conceive 
brain-changes of a universal character, such as the universal liver 
changes in phosphorus poisoning, as underlying these diseases. 
No doubt there are instances of such universal brain-change and 
no doubt mental symptoms occur as a consequence. Hyper- 
pyrexia might serve as an example. General paresis, however, 
our paradigm in this field, despite the severe and widespread 
brain changes which characterize it, is still an example of a dis- 
ease of focal character. From its protean and progressive char- 
acter, a theoretically similar focality for brain lesions in dementia 
prsecox was thought probable. The mild, irritative and persist- 
ently complex character of many symptoms in dementia praecox 
seemed to argue very mildly destructive or irritative lesions, such 
that an occasional definite cure or disappearance of a given 
symptom or set of symptoms could be effected by removal of 
irritating factors or by advancing destruction of the offending 
elements. 

If these contentions were sound, it became clear that no random 
block of brain tissue could demonstrate the nature of dementia 
praecox, as a particular block of lung tissue might demonstrate 
that of pneumonia. Neither would all the cells be equally or 
peculiarly aft'ected nor would the cells of certain strata do more 
than demonstrate the effects of disease in those strata. 

But, if the cells or strata of no random block of brain tissue 
could serve as a test of dementia prajcox, would not particular 
and happily chosen blocks, or even ideally possible total-brain 



172 A STUDY OF DEMENTIA PR-ECOX [July 

sections suitable for cytopathology, solve the problem. I sup- 
pose all would agree that such work might solve the problems at 
least of localization and possibly of pathogenesis in dementia 
prascox, provided that the disease is really a brain disease. 

I therefore began to study all cases of dementia prjecox ac- 
cessible to me (the protocols and prepared sections from the 
Danvers collection made in Prof. Barrett's service and my own), 
to get a general view of the subject. As will be seen, I at first 
included with type cases also cases only doubtfully belonging in 
dementia prsecox, and these I have excluded from the conclusions 
of this report, although many exhibited lesions which might well 
serve, if we were surer of our conditions, to bring the cases 
back into the group. 

The histopathology, although studied in connection with many 
of the lesions, has been left in the background to avoid involve- 
ment in a tangle of discussion concerning intracortical reflex-arcs. 

Conclusions. 

1. Existent evidence for the organic nature of dementia prae- 
cox is not wholly convincing, since (a) the cytological changes 
described are found also in cases of toxic deliria and in cases 
complicated by severe visceral disease, and (b) the stratigraphic 
changes described are found also in certain senile cases without 
characteristic symptoms of dementia prxcox. 

2. Resort must, therefore, be had to the topographic idea, for 
the adequate exploitation of which total-brain sections, with cyto- 
logical exploration of all areas, are ideally necessary. 

3. Random blocks of brain tissue with demonstration of satel- 
litosis, infrastellate gliosis, or disintegration products of cell dis- 
order will throw little light on the mechanism of dementia 
prsecox. 

4. The data of the functionalists (dissociation, sejunction, in- 
trapsychic ataxia, and the like) are of the utmost importance as 
indicating the essential focality of tlie pathogenic process and 
the focal variations in its severity. 

5. The curability of certain cases, the remissive character of 
some cases, the speedy disappearance of particular symptoms, the 
persistent complexity of reaction in some instances, the absence 
of characteristic severe projection-system symptoms, all indicate 



I9IO] E. E. SOUTHARD I73 

that the process is histopathologically mild and that the focal 
changes found will be but slightly destructive or even irritative 
(in the sense of slight injuries readily repaired or compensated 
for). 

6. Grossly destructive lesions of a transcortical character in 
Wernicke's sense might conceivably effect, c. g., a permanent 
katatonic complex and doubtless will be found to do so occasion- 
ally ; but the protean and progressive character of dementia prse- 
cox will exclude such transcortical injuries from playing a large 
part in the pathogenesis. 

7. The focal lesions to be sought for will doubtless escape 
macroscopic notice in many instances, since the volume of appa- 
ratus engaged in effecting very prominent symptoms is often 
slight and spread very thin in numerous areas. 

8. Studies of the " soft brain " and of gliosis in epilepsy have 
proved, however, that even comparatively slight degrees of corti- 
cal gliosis can often be palpated at autopsy. 

9. Palpable glioses of a focal or variable character, combined 
in numerous instances with visible atrophy and microgyria, have 
been found in over half the series under examination, in cases re- 
garded as clinically above reproach and not subject to coarse 
wasting processes, focal encephalomalacia, cortical arteriosclero- 
sis, or diffuse chronic pial changes. 

10. The frequent co-existence of several foci of sclerosis or 
atrophy in the same brain and the microscopic observation of 
milder degrees of nerve-cell disorder and gliosis in regions with- 
out gross lesions tend to the conception that the agent is more 
general and diffuse in its action than would seem at first sight, 
so that future research may well demonstrate that certain in- 
stances of coarse brain wasting and even of diffuse chronic lepto- 
meningitis belong in the group (microscopic corroboration neces- 
sary for assigning values to focal variations). 

11. The microscopic examination of the residue of cases in 
which gross lesions or anomalies were not described shows the 
same tendency to gliosis and satellitosis in numerous instances 
and the same tendency to focal variations from gyrus to gyrus 
exhibited by the gross lesion group. These findings suggest that 
the minor gross lesions and anomalies of several cases actually 
escaped notice (the protocols, though drawn up with a certain 



174 A STUDY OF DEMENTIA PRECOX [July 

system, are by various hands) at autopsy, so that the probable 
actual proportion of gross lesions is 68 per cent. If microscopic 
evidence is resorted to, the " organic " proportion in our series 
rises to 86 per cent. 

12. Several groups of cases were classified from the distri- 
bution of macroscopic lesions, although the focal purity of these 
cases can often be brought in question from the results of micro- 
scopic examination (infrastellate gliosis and satellitosis also in 
macroscopically "normal" areas). 

I. Pre-Rolandic group, including a superior frontal-prefrontal 
sub-group of paranoidal trend {cf., e. g., case 1062). 

II. Post-Rolandic group, including (a) postcentral-superior- 
parietal (sensory-perceptual) sub-group in which katatonic feat- 
ures are the common factors (cf., e. g., case 1298) ; (b) occipital 
sub-group (cf. case 1149). 

III. Infra-sylvian group (too small for clinical correlations). 

IV. Cerebellar group (katatonic features). 

13. If these data find general confirmation, they will doubtless 
go far to unify discussion, since mild, variable and progressive 
intracortical lesions, proceeding at different rates in different 
parts of the apparatus, and having the peculiar distributions in- 
dicated above, would explain adequately some of the contentions 
of the dissociationists, while remaining not wholly inconsistent 
with Kraepelinian ideas. 

14. The frontal-paranoid correlation is in line with modern 
physiological ideas, but it must be granted that the occipital and 
temporal regions, as elaborating important long-distance impulses, 
may well play a part also in paranoid states. 

15. The cerebellar-katatonic correlation is doubtless in line 
with some contentions of the Wernicke school, and obvious com- 
ments might be made in conection with the proprioceptive func- 
tions of the cerebellum (Sherrington). 

16. The postcentral-superior-parietal relations to katatonic 
symptoms are perhaps theoretically the most novel suggestion 
from the work, but here again the results are not inconsistent 
with modern physiologj'. 

17. The topographic study of dementia praecox brains, both 
gross and microscopic, is commended as likely to shed new light 
on the pathogenesis of certain symptoms, notably paranoidal and 
katatonic symptoms. 



igio] E. E. SOUTHARD 1/5 

REFERENCES. 

1. Alzheimer: Beitrage zur pathologischen Anatomie der Hirnrinde und 

zur anatomischen Grundlage einiger Psychosen. Monatschr. f. 
Psychiat. u. Neurol., 2, 1897. 

2. Klippel et Lhermitte : Anatomie pathologique de la Demence precoce. 

Soc. de Psychiat. de Paris, 19 Nov., 1908, Rev. neurol., 1908. 

3. Sioli : Histologische Befimde bei Dementia praecox. 82. ordentl. Gen- 

eralvers. des psychiat. ver. du Rheinprovinz am 14. Nov., 1908, in 
Bonn. Zentralbl. f. Nervenh. u. Psychiat., 32, 1909. 

4. Alzheimer : Beitrage zur Kenntnis der pathologischen Neuroglia und 

ihrer Beziehungen zu den Abbavvorgangen im Nervengewebe. 
Nissl u. Alzheimer's Histol. u. Histopatholog. Arbeiten, 3, 3, 1910. 

5. Gay and Southard : The Significance of Bacteria Cultivated from the 

Human Cadaver : A Study of 100 Cases of Mental Disease, with 
Blood and Cerebrospinal Fluid Cultures and Clinical and Histo- 
logical Correlations. Centralbl. f. Bacteriologie, 1910 (in press). 

6. Southard and Canavan : Bacterial Invasion of the Blood and the Cere- 

brospinal Fluid by Way of Mesenteric Lymph Nodes : A Study 
of so Cases of Mental Disease. Boston Med. Surg. Journ., 1910 
(in press). 

7. Gross : Cited by Kolpin. 

8. Kolpin : Ueber Dementia prascox. insbesondere die paranoide Form 

derselben. Allg. Zeitschr. f. Psychiat., 65, 1908. 

9. Wolflf: Zur Frage dur Benennung der Dementia prascox Zentralbl. f. 

Nervenh, 31, IQ08. 

10. Zweig: Dementia praecox jenseits des 30. Lebensjahres. Archiv f. 

Psychiat., 44, 1908. 

11. Bleuler: Referat: Die Prognose der Dementia Praecox (Schizo- 

phreniegruppe). Verb, des deutsch. Vereins f. Psychiat. zu Berlin, 
April, 1908. Allg. Zeitschr. f. Psychiat., 65, 1908. 

12. Dromard : Apraxie et demence precoce. L'Encephale, 3, 1908. 

13. Meyer: Fundamental Conceptions of Dementia Praecox. Brit. Med. 

Journ., igo6. 

14. Stransky: Ueber die Dementia Praecox. Streifziige durch Klinik u. 

Psychopathologie, 1909. 

15. Urstein : Die Dementia Prascox und ihre Stellung zum Manisch- 

depressiven. Irresein, 1909. 

16. Southard and Mitchell : Clinical and Anatomical Analysis of 23 Cases 

of Insanity Arising in the Sixth and Seventh Decades, with Espe- 
cial Relation to the Incidence of Arteriosclerosis and the Distribu- 
tion of Cortical Pigments. Am. Journ. Insanity, 65, 2, 1908. 

17. Southard : Anatomical Findings in Senile Dementia : A Diagnostic 

Study Bearing Especially on the Group of Cerebral Atrophies. Am. 
Journ. Insanity, 66, 4, 1910. 

18. Alzheimer : Die diagnostischen Schwierigkeiten in der Psychiatric. 

Zeitschr. f. d. ges. Neurol, u. Psychiat., I, i, 1910. 



176 A STUDY OF DEMENTIA PRECOX [July 

19. Southard : Encephalitis and Brain Abscess. Osier's Modern Medicine, 

VII, 1910. 

20. Southard : The Neuroglia Framework of the Cerebellum in Cases of 

Marginal Sclerosis. Journ. Med. Research, 13, 5, 1905. 

21. Southard : On the Mechanism of Gliosis in Acquired Epilepsy. Am. 

Journ. Insanity, 64, 4, 1908. 

22. Southard and Hodskins : Note on Cell-Findings in Soft Brains. Am. 

Journ. Insanity, 64, 2, 1907. 

23. Southard : Lesions of the Granule Layer of the Human Cerebellum. 

Journ. Med. Research, 16, 1907, p. 107. 

24. Southard and Ayer : Dementia Precox. Paranoid, Associated with 

Bronchiectatic Lung Disease and Terminated by Brain Abscesses 
(Micrococcus catarrhalis). Boston Med. Surg. Journ., 159, 1908. 

25. Kleist : Untersuchungen zur Kenntnis der psychomotorischen Beweg- 

ungsstorungen bei Geisteskranken, igo8. 

26. Wundt: Volkerpsychologie, i. Bd. Die Sprache, igoo, S. 491-518. 



REPORT OF THE COMMITTEE ON MEDICAL EXPERT 
TESTIMONY OF THE AMERICAN MEDICO- 
PSYCHOLOGICAL ASSOCIATION.* 

In the torrent of comment and contention which has long been 
raging about medical expert testimony, there has been thus far 
no concerted expression of opinion from the alienists of this 
country who are the chief targets for the adverse and widespread 
criticism that prevails on this subject. It it time, therefore, that 
the position of this Association on this question in its various 
aspects and particularly as it relates to the insanity defence in 
criminal cases should be clearly defined, and the difficulties under 
which the alienist labors and the injustice done him made plain. 

This is the tenor of the resolution which led to the appointment 
of your committee and in this report and the accompanying reso- 
lutions we have undertaken the ver>' difficult task of so presenting 
the issue that it shall represent the united opinion of this Asso- 
ciation in so far as it bear on the attitude and position of its 
members. 

■The mmiber of alienists who figure in homicide trials or for 
that matter in medico-legal cases of any description is insignifi- 
cant when compared with the cloud of medical witnesses giving 
expert testimony in cases arising from personal injury which are 
largely responsible for the flood of litigation which is overwhelm- 
ing our courts. Many of these witnesses also are general physi- 
cians whose opinions are not based on special accomplishment in 
any single branch of medicine. Therefore, there necessarily must 
be far more opportunity for defective medical testimony to be 
oflfered in such cases than during criminal trials in which the 
question of insanity is involved. 

Nevertheless it is the physician in mental diseases whose evi- 
dence has to bear the brunt of public criticism and abuse because 
of the importance of the issue and the wide publicity given to 

* Presented at the sixty-sixth annual meeting of the American Medico- 
Psychological Association, Washington, D. C, May 3-6, loio. 



178 REPORT OF THE COMMITTEE ON [July 

details of murder trials of which his testimony is a conspicuous 
feature. The physician who is called to testify on purely medical 
or surgical questions is brought into no such prominence. On 
the other hand, all eyes are on the alienist and so great is the in- 
dignation and desire for retaliation on the murderer that except 
in the most obvious cases of insanity any medical testimony which 
favors irresponsibility is sure of hostile scrutiny from the start 
no matter how sound and unbiassed it may be. 

The alienist on the witness stand faces, therefore, a great 
responsibility and a single dishonest physician may bring more 
discredit upon himself and his medical brethren because of this 
prominence than a dozen unscrupulous medical witnesses in acci- 
dent cases. That this Association is fully alive to this responsibil- 
ity is plainly shown by the number of its members who have long 
taken active part in directing attention to the " evils " of medical 
testimony in court and in seeking their remedy. 

The dangers to the cause of justice that are supposed to lie 
in the insanity defence for crime are without question greatly 
exaggerated. Too much has been taken for granted and little or 
no inquiry made as to the actual results of its operation. There 
is no way by which we can approach a more accurate estimate 
of the number of homicidal criminals who have escaped their 
just deserts by this means than by ascertaining how many sane 
criminals of this class have been committed as insane to hospitals 
for the insane in a given period. In reply to inquiry on this point 
the superintendents of 75 out of 108 hospitals in this country and 
Canada, with a population of over 83,230 inmates, report but 
seven criminals who had been charged with homicide who had 
been improperly adjudged insane and sent to hospitals for the 
insane during the past two years. Superintendents of special 
institutions for the criminal insane report that very few criminals 
of any kind are wrongly adjudged insane and committed to their 
institutions — not a dozen in twenty years according to Dr. Lamb 
of the Matteawan institution for this class — while the period of 
hospital residence of discharged cases shows that they underwent 
a longer confinement as insane patients than would have followed 
had the same men been convicted and sent to prison. 

The real injustice in this matter is that the insanity defence 
is not by any means employed as often as it should be. In other 



I9IO] MEDICAL EXPERT TESTIMONY I79 

words, much more harm results from lack of expert testimony 
than from its defects. There are far more instances of the com- 
mitment of insane persons to prison for want of preHminary ex- 
amination and recognition of their mental condition than there 
are of the commitment of sane criminals to hospitals for the in- 
sane. Many so-called criminals are convicted and sent to prison 
only to be found insane and transferred to the asylum for criminal 
insane. Such patients are wholly out of place in prisons where 
they are not only stigmatized as felons and deprived of the proper 
and humane care that is their due, but are made worse by prison 
discipline, while the difficulty of enforcing prison rules in their 
cases greatly interferes with proper administration. Dr. Allison 
has reported that 53 per cent of 179 insane persons under his 
charge at the asylum for the criminal insane at Matteawan who 
had committed murder were received from prisons to which they 
had been sentenced for life. Their histories and the character and 
course of the disease showed that at least 40 per cent of such con- 
victed cases were insane at the time the crime was committed. In 
many instances the fact of their insanity was not recognized at the 
time of their trial, but in others the plea was set up and failed. 
Wherever this matter has been made the subject of inquiry this 
has been the story in all large prisons and institutions in which the 
criminal insane are received both in this and in foreign countries. 
The lowest estimate from authoritative sources, and a most con- 
servative one. is that ten insane persons are made convicts to one 
malefactor who escapes punishment on the plea of insanity.' 

In the important matter of the responsibility of the insane for 
crminal acts we hold that it is not the province of the alienist in 
the medico-legal cases to pass upon the legal or criminal respon- 
sibility of insane persons. That is a question for the judge or 
jury to decide. A medical man giving expert testimony has only 
to say whether or not in his opinion insanity is shown by the evi- 
dence. It is admissible, however, to call attention to the fact that 
insanity in the medical sense does not imply total irresponsibility. 

The capacity of an individual to distinguish between right and 

' MacPherson, a Scotch authority, beheves that " hitherto the law has cer- 
tainly erred on the side of severity and has hanged ninety-nine irrespon- 
sible persons for one responsible person who has escaped' on the plea of 
insanity" ("Mental Aflfections," p. 374.). 



l8o REPORT OF THE COMMITTEE ON [Jul.V 

wrong as a test of legal responsibility is in direct conflict with the 
laws of nature and hence unscientific and false in its application 
to the mentally unsound. The real questions for the jury to de- 
termine in cases of alleged insanity in criminal trials are : 

1. Did the defendant at the time of the alleged crime have 
sufficient mental capacity to rationally appreciate the nature and 
consequence of the act he was committing and if so had he 
sufficient power of will to enable him to choose between doing and 
not doing it? 

2. If he had lost the power of choosing with reference to the 
particular act was the loss due to disease, and not to " heat of 
passion " intoxication or other self-induced temporary mental 
disturbance ? 

The chief obstacle to accurate expert testimony encountered 
by the physician is the difficulty — often the impossibility — of ob- 
taining all the important evidence that is procurable on both sides 
of the case. Without this an unqualified opinion of real value can- 
not be given except where the insanity (for example) of the 
accused person is plainly apparent. We shall of course be told 
that on the contrary even the medical man who only forms his 
opinion after he has examined the accused person and has heard 
all the evidence submitted in court will still be biassed in favor 
of the side which employs him, and that there lies the whole 
trouble. To this we can only oppose our conviction that with the 
majority of physicians the professional instinct outweighs par- 
tisan and mercenary considerations and that when they have all the 
data for a diagnosis at hand they will give as accurate and impartial 
an opinion on the witness stand as they would in any case occur- 
ring in their daily practice. Were this not so, we should be forced 
to conclude either that medical men yield more readily to pecun- 
iary temptation than members of the other professions or that 
most men whatever their calling and standing in the community 
are not radically honest where a fee is concerned. 

True reform in medical testimony does not in our opinion lie 
in a radical change in present methods of legal procedure. It is 
in the hands of the medical profession, and if physicians would 
cooperate in refusing to testify unless free access to all obtainable 
evidence on both sides should be forthcoming we should hear 
little of the shortcomings of the medical expert. 



igiO] MEDICAL EXPERT TESTIMONY l8l 

It frequently happens that the medical witness is debarred from 
making any examination whatever of the person accused or ques- 
tioned. Counsel for the defendant may decline to have his client 
examined and will be sustained by the court. Not only this, but 
the medical man on one side may examine the person while the 
same privilege is denied the physicians called on the other. 

Sometimes we are allowed neither a personal examination or 
the evidence on which to base our opinion, but are obliged to 
answer only a hypothetical question, a procedure which can bear 
no comparison with either as a means of ascertaining the truth. 
In spite of the utility and justice of the hypothetical question in 
the opinion of the legal profession, it can never find favor with 
medical witnesses. As a rule it is not at all what it represents 
to be, for to quote Ray — that master of medical jurisprudence — 
if the case put to the jury is precisely what appeared in evidence 
it is quibbling to call it a hypothetical case. If, on the other hand, 
a genuinely supposititious case is put to the expert the less it 
resembles the actual case the less will it enlighten the jur)'. How- 
ever, nobody supposes that the hypothetical cases stated by counsel 
always represent cases that have actually occurred, for it is well 
understood that they may be merely a collection of such particu- 
lars as best suit the counsel's purpose. A true reform would be to 
confine the expert to the case in hand as revealed by the evidence 
and debar him entirely from giving opinions on hypothetical cases. 
But although there are signs that the hypothetical question is 
less generally utilized than was formerly the case we have little 
expectation that it will disappear from court practice. With per- 
sistence however we may reasonably expect that in its presentation 
to the medical witness the essential evidence on both sides will be 
included and a source of much humiliation to the testifying physi- 
cian and deception of the jury be removed. 

The advantages to come of consultation by the medical wit- 
nesses on both sides of a case are admittedly great, because 
directly in line with medical methods where a careful diagnosis 
is to be made and the real condition of the patient ascertained. 
We are therefore in hearty sympathy with the familiar sentiments 
of Sir James Stephen who says : 

" If medical men laid down for themselves a positive rule that 
they would not give evidence unless before doing so they met in 
13 



l82 REPORT OF THE COMMITTEE ON [J"ly 

consultation the medical men to be called on the other side and 
exchanged their views fully, so that the medical witnesses on the 
one side might know what was to be said by the medical witnesses 
on the other, they would be able to give a full and impartial 
account of the case that would not provoke cross-examination. 
For many years this course has been invariably pursued by all 
the most eminent physicians and surgeons in Leeds, and the result 
is that in trials at Leeds (where actions for injuries in railway 
accidents and the like are very common) the medical witnesses 
are hardly ever cross-examined at all, and it is by no means un- 
common for them to be called on one side only. Such a practice, 
of course, implies a high standard of honor and professional 
knowledge on the part of medical witnesses, but this is a matter 
for medical men. If they steadily refuse to act as counsel and 
insist on knowing what is to be said on both sides before they 
testify, they need not fear cross-examination." 

The bar has its duty as well and should oftener take the initia- 
tive in securing such consultations. The prosecution and defence 
should oftener come together and agree upon the experts to be 
appointed, who should then conjointly examine the prisoner, col- 
lect all obtainable evidence, and submit their report to counsel on 
both sides. Mercier in his work on criminal responsibility cites a 
famous case recently tried in Massachusetts ' in which this method 
was pursued with most satisfactory results, the counsel on both 
sides agreeing to abide by the decision of the commission. " This," 
he says, " seems an eminently satisfactory way of determining 
this difficult question. The case is not withdrawn from the con- 
sideration of a court of justice, but is tried in the ordinary way, 
the only difference being that the jury have not to estimate the 
value of conflicting opinions but are guided to a direct conclusion 
by a unanimous medical report The consultation of ex- 
perts could scarcely fail to approximate their opinions even if they 
eventually differed and I think the practice is well worthy of a 
trial." 

We also strongly favor the appointment of commissions wherever 
possible. Cases of crime of minor degrees in which the question of 

' Reported by Stedman in the American Journal of Insanity, Vol. LXI, 
No. 2, 1904. 



I9IO] MEDICAL EXPERT TESTIMONY 183 

insanity is raised have long been passed upon and their proper 
disposal effected by commissions appointed by courts and the prac- 
tice is increasing. There is ample evidence to show that capital 
cases in which the plea of insanity is raised may also be passed 
upon by commission with etjually good results and with full recog- 
nition of their graver aspects. It is a frequent practice in Massa- 
chusetts to refer such questions to a commission of alienists and 
the results have been most satisfactory. The chief objection to the 
commission is that no body of physicians is able to elicit from 
witnesses testimony that in amount and importance will equal that 
which can be brought out by direct and cross examination on the 
witness stand by able lawyers. There is much truth in this, but it 
is equally certain that the counsel's unfamiliarity with mental 
disease often leads him to miss or neglect vital points evidencing 
insanity or its absence which quickly occur to the alienist, and 
which are far more accessible in private than in the publicity of 
the court room. A commission, moreover, often saves the expense 
and other disadvantages of a trial, and should the case come to 
trial the testimony of the members of the commission would carry 
especial weight. 

But even if the foregoing methods could always be employed 
the important requisite of a thorough examination of the prisoner 
might still be wanting. This is not unfrequently the case where 
the physician's opportunity for observing him is confined to occa- 
sional visits to the jail and would be wholly obviated if a period 
of constant medical observation could be substituted for it. We 
are therefore strongly in favor of hospital observation in such 
cases pending the determination of the subject's mental condition. 
This method has long been in very satisfactory operation in 
Maine, New Hampshire and Vermont, and is taking root in 
Massachusetts under recent enactments. It has many advantages. 
The daily and hourly habits and conduct of the person are under 
the close and constant observation of trained physicians and 
nurses. This is invaluable in cases having concealed delusions who 
may refrain for weeks and months from unburdening their minds 
to the examiners. Persistent feigning also can be far more easily 
and quickly detected under these conditions owing chiefly to the 
difficulty the offender experiences in keeping up the pretence of 
insanity uninterruptedly and consistently when he is closely 



184 REPORT OF THE COMMITTEE ON [Julv 

watched night and day. But it is especially advantageous in 
notorious capital cases. Here removal of the person from public 
notice to a hospital for observation is quite certain to be effective 
in silencing the popular clamor and sensational reports that 
usually attend such cases. The delay it involves also tempers pub- 
lic opinion as does the evident intent of thorough investigation 
that is shown in a term of hospital observation. There can be 
moreover no suspicion of bias attaching to the unpaid opinion of 
State medical officers and the State is also saved considerable ex- 
pense. Moreover the testimony of a hospital physician when based 
on such abundant opportunity for study of the case usually carries 
more weight with court and jury than that of other medical wit- 
nesses. Finally, under this method shorter trials are the rule. 

Much, we believe, would be gained by the restoration of the 
common law practice wherever it has been abolished which allows 
the judge to advise the jury in the decision of complicated ques- 
tions of fact and to aid them in weighing and sifting evidence that 
is of a scientific or technical nature. Such a provision would be 
especially applicable to questions of insanity. 

There are also more purely ethical questions which are of de- 
cided importance to the medical witness and the repute of the 
profession. It is, for example, a questionable practice for the 
physicians to take active part in a medico-legal case by advising 
with counsel in open court. By so doing he exposes himself to 
the charge of undue bias, his testimony is regarded as partisan by 
court and jury, and his attitude is out of keeping with professional 
dignity. 

The acceptance of a fee contingent upon the outcome of a case 
is a most objectionable and indefensible practice. An unbiassed, 
independent opinion is practically impossible under these circum- 
stances and the physician becomes an active partisan at once. His 
testimony is also valueless if he is forced to admit that his com- 
pensation depends upon the result of the case. 

It is very desirable to establish some standard of qualification 
for the medical expert especially in cases involving the question of 
insanity. In no other branch of expert work is special training 
and experience more necessary in forming opinions of real value 
and yet it is a common occurrence in most states for physicians 
with little or no special knowledge of, or practice in, mental dis- 



igio] MEDICAL EXPERT TESTIMONY I85 

ease to qualify as experts. A step in this direction might we be- 
lieve be made by the establishment in the various states of bodies 
of official experts designated by the higher courts any of whom 
could be called on to testify as experts by either party to a civil or 
criminal action without however limiting the right of parties to 
call other expert witnesses as heretofore. This plan, although 
falling far short of the desired end, should at least tend in the 
long run to lessen the number of incompetent medical experts. 

In conclusion we offer for adoption the following resolutions 
which shall represent the attitude of the American Medico-Psy- 
chological Association on the question of medical testimony as it 
affects the alienists of this country: 

Resohed: i. That the proved rarity of wrong acquittals on the ground 
of insanity is the strongest evidence that the abuse of the insanity plea in 
criminal cases has been unwarrantably exaggerated. 

2. That the insanity plea is not by any means raised as often as it should 
be, to prevent the frequent miscarriage of justice arising from the convic- 
tion and imprisonment of insane persons whose true mental condition has 
not been recognized. 

3. That the abuses which have crept into the method of presenting med- 
ical expert testimony have been largely the result of established legal tests 
and procedures, although their correction does not require radical change 
in the laws. 

4. That inaccessibility of the evidence on both sides of the case is the 
chief cause of defective medical testimony. 

5. That whenever possible the medical witness should not testify unless 
he has had an opportunity to make both a mental and a physical examina- 
tion of the person in whose behalf the plea of insanity is raised. 

6. That we consider the hypothetical question as ordinarily presented to 
be unscientific, misleading and dangerous to medical repute and that the 
evidence on both sides should always be included in its presentation to 
medical witnesses. 

7. That in all criminal cases absolutely equal rights should be accorded 
the medical witnesses for both the prosecution and the defence for the 
examination of the person alleged to be insane. 

8. That in our judgment the judiciary should by legal enactment be 
allowed more latitude in enlightening the jury and enabling it to compre- 
hend the nature and meaning of the medical testimony laid before it. 

9. That we recommend as advisable the adoption wherever possible of 
the so-called Leed's method of preliminary consultation by medical wit- 
nesses on both sides of the case as to its status. 

10. That we advocate a freer use of appointments of commissions by the 
court. 



l86 MEDICAL EXPERT TESTIMONY 

11. That a period of hospital observation of all persons committing 
crimes in whose defence the plea of insanity has been raised is by far the 
best method yet devised for securing impartial and accurate opinions, 
silencing popular clamor, avoiding prolonged and sensational trials and 
saving expense to the State ; also that we advocate the enactment in every 
State of laws similar to those of Maine, New Hampshire, Vermont and 
Massachusetts, providing that such persons may be committed by the court 
to a State hospital for the insane there to remain for such time as the 
court may direct pending the determination of their insanity. 

12. That it is the sense of the Association that it is subversive of the 
dignity of the medical profession for any of its members to occupy the 
position of medical advisory counsel in open court and at the same time 
to act as expert witness in a medico-legal case. 

13. That we regard the acceptance by a physician of a fee that is con- 
tingent upon the result of a medico-legal case as not in accordance with 
medical ethics and derogatory to the good repute of the profession, and 
advocate the regulation of the practice by legislation. 

14. That we are in favor of any legislation that will secure a definite 
standard of qualification for medical men giving expert testimony. 

Henry R. Stedman, M. D. 
Carlos F. MacDonald, M. D., 
Charles K. Mills, M. D., 
Charles P. Bancroft, M. D. 
H. A. Tomlinson, M. D. 



IBotes ant) Comment. 



Dr. Page's Address. — " What Nurses Gain by Treating In- 
sane Patients without Mechanical Means of Restraint," is the 
somewhat cumbersome, but very definite title of the address of Dr. 
C. W. Page, the retiring superintendent of the Danvers State 
Hospital, to the graduating class of nurses of that institution. To 
those persons who were in the habit of reading the American 
Journal of Insanity 40 years ago the sentiments expressed in 
the address would seem little short of madness. It was then gen- 
erally taken for granted in the United States and Canada that the 
only course to pursue with those insane persons who were not 
capable of self-control was to control them from without by 
mechanical means. It was asserted and believed that insane 
patients should be protected from themselves and from each other. 
Richard Gundry, of Ohio, in 1875 ; R. M. Bucke, of Ontario, in 
1880; W. B. Fletcher, of Indiana, in 1886, and others showed 
the fallacy of these statements and soon demonstrated in a 
practical manner that mechanical restraint was not curative but 
rather increased and aggravated the mental manifestations. In fact 
it soon became evident, as the result of experience, that many of the 
worst characteristics of the violent, homicidal insane were directly 
traceable to the use of such means of restraint. With non- 
restraint came a conviction that insane persons should be treated 
as sick persons and their restlessness should be relieved by occu- 
pation, amusements, good food, fresh air and good careful nursing 
from trained and skilled nurses. The keeper and attendant dis- 
appeared and the nurse came into being. To advocate any other 
method of treatment would now be justly considered a return 
to the methods of the darker ages of psychiatry. It is, however, 
refreshing to read the address and to recognize how great an 
advance has been made in one or two generations. The tribute 
in the addres.« to the nurses who have been trained in the newer 
method of caring for patients would have fallen upon dull ears 
and irresponsive minds then. Now they indicate very felicitously 



l88 NOTES AND COMMENT [Ju'y 

the change which has taken place in the jxiint of view of the nurse 
towards her charge. He says, after referring to the prohibition of 
all mechanical means of restraint: 

How, then, have you succeeded in managing patients ? Those who have 
had practical experience in such hospitals know that you have not abdi- 
cated authority, but that you have discarded its more objectionable possi- 
bilities, and have appealed to a higher grade of authoritative expedients, — 
the authority of reason over unreason ; the power of persuasion ; of appro- 
priate, soothing words; of genuine sympathy; of applied philanthropy; 
broad humanity, tact in its best sense. 

The rules laid down for your guidance in this trying work were only 
general ones. Explicit directions calculated to meet the requirements of 
individual cases could not be successfully formulated in advance, because 
the personality of each patient varies and the personality of a given patient 
often presents a new phase. Besides the personality of the nurses differing 
each one from all others, in some particular or some degree, must in each 
case have a bearing upon the method employed. 

Nine-tenths of all possible friction between you and your patients has 
been nullified by your avoidance of coercive measures and by establishing 
friendly relations with them upon early acquaintance. This good work has 
been helped on by always giving them time to understand your requests 
and an extension of time when necessary to comply with your commands, 
and by not insisting upon literal compliance with your request when ready 
obedience in a modified manner or sense accomplished the desired end. 
No doubt you have been taxed, and severely, at times, to retain control of 
a situation. On the spur of the moment, you have had to invent and adopt 
expedients for the purpose of distracting the attention of some patient 
verging on an outbreak of excitement or violence. By quiet dignity, a 
calm, positive manner and a firm, straightforward look you have been able 
to dissuade some deluded patient of hostile intention. You have had to 
supply those under your care with wholesome mental suggestions in such 
numbers and variety that the effort may be likened to an exercise in mental 
gymnastics. You have learned how worse than useless it is to use nega- 
tively expressed injunctions in attempts to alter a patient's evident pur- 
pose, or change a habit of dwelling upon depressing mental subjects. You 
have found that the expressions, " Don't do this, or that," " You must not, 
or shall not, do thus and so," intensify a person's attention upon the for- 
bidden idea or intent, making it so much the more difficult for patients to 
act as you desire. 

You have discovered the more efficient, the scientific, positive method by 
which to accomplish the desired end's ; that of supplanting the distressing 
or dangerous train of thought by suggesting new topics for contemplation- 
avoiding painful attempts at extraction and depending upon successful 
substitution. 

To habitually practice the better way requires presence of mind, active 
thinking, and all the wit a nurse can command. It also involves the most 



I9IO] NOTES AND COMMENT 189 

efficient sort of discipline for the nurse, that of self-discipline. When 
tantalized, defied or insulted, the true nurse — imbued with the proper spirit 
of non-restraint — must suppress indications of ill-temper, must even learn 
to receive blows without a display of resentment. 

You have had to give courage to the disconsolate, lend sympathy and 
endeavor to impart faith in a long list of melancholy victims, although your 
proffered assistance has seldom been appreciated. Fortunate indeed have 
you been did nature supply you with a large measure of optimism. 

Honesty of purpose and expression on your part must have been your 
rule else your work has been of little value to the patients and less to your- 
selves. Falsifying to patients is a deplorable practice. Your altruistic 
sentiments have been fostered by interest in, and sympathy for, the un- 
fortunates. You have diligently searched mental ruins for some vital spark 
that might respond to the sunny influence of sympathy. 

Where superficial observation has shown only evidence of degeneracy, a 
closer study has revealed to you spots of goodness which by cultivation 
have so leavened the individual as to produce decided improvements. 

Thus, in various ways, it has been necessary to measure your mental 
capacity against the patient's cunning and will so constantly that you have 
developed your full mental stature ; that you are ready and willing to 
measure yourself at any time with any party it becomes necessary for you 
to meet. In dealing with the insane in a non-restraint hospital, you have 
had to depend largely upon your own mental resources. You have over- 
come trying, difficult obstacles because you have successfully drawn upon 
your own innate mental endowment. In this way you have evoked a latent 
capacity which except for the exigencies of the various cases you have 
managed, would have remained dormant, and perhaps indefinitely. 

This process has been one of auto-education — education in the true sense 
of the term, drawing-out, developing, utilizing your natural talent. 

In earning your diploma in this school, you have acquired an art which 
will promote your usefulness and success at every step in your future 
career. 

I think all must agree that a nurse's training in a " non-restraint " hospital 
is a decided success in developing character and practical knowledge. 

Indeed, I challenge anyone to name an established educational course 
which will in the same length of time, better develop a student's natural 
ability, and better fit one for practical success in life. 

These are stimulating words to those who have learned to care 
for the insane by the true methods of nursing. Dr. Page could 
not have done a better service to the insane than he has done by 
pointing out the cardinal virtues of non-restraint. It is a matter 
of sincere regret to those who have watched the growing use- 
fulness of the Danvers State Hospital to know that the guiding 
hand of Dr. Page has been withdrawn. May he enjoy the rest 
and quiet which he has so well merited I 



190 



NOTES AND COMMENT 



[July 



Expert Testimony and the Report of the Committee of 
THE American Medico-Psychological Association upon the 
Subject. — We are happy in being able to present in this number 
of the Journal the report of the committee appointed at the 
Atlantic City meeting of the Association in 1909 upon the subject 
of medical expert testimony. The report will, in our opinion, be 
found to be a fair, unbiased and dispassionate treatment of the 
subject and one which will, we trust, be effective in working 
material reform in some of the methods pursued in the presenta- 
tion of medical opinions in court, and in the employment of expert 
witnesses on medical questions. 

We have said that the report is an unbiased one. The same 
could be said of it had the committee placed more emphasis upon 
the fact that in a large degree the matters which are most severely 
criticised in relation to medical expert testimony have largely to 
do with the method of selecting witnesses to give expert testimony 
and the manner in which such testimony is permitted to be given, 
and that in both these the legal profession is almost wholly at 
fault. We are not, however, questioning the wisdom of the 
committee in refraining from placing more definitely than it has, 
much of the blame for the existing state of affairs where it be- 
longs upon the legal profession as represented both by the bench 
and the bar. Neither are we proposing to plead lack of guilt 
upon the part of the medical profession for as the committee 
plainly intimates much either in the way of commission or 
omission may be laid at its doors. 

The twelfth in the series of resolutions offered by the com- 
mittee touches upon a fault that is too often observed in those 
who appear as medical experts, occupying the position of medical 
advisory counsel in open court and at the same time acting as 
expert witness in the same case. 

The medical witness who sits beside counsel who coaches him 
with questions intended often solely to catch or confuse the expert 
who has been called for the opposite side invariably gives to the 
court and jur\' an impression of partisanship which must largely 
diminish, if not wholly destroy, the value of his testimony. During 
the course of the examination of witnesses, lay or medical, expert 
witnesses may often desire to suggest questions to counsel which 
may bring out more clearly certain points upon whicli they may 



IpIO] NOTES AND COMMENT I9I 

desire information, but such questions alone should be put to 
counsel and, if possible, in a way that would show to court and 
jury their real purport. 

Not only will the resolution concerning contingent fees be 
approved, but a clause might have been added deprecating the 
acceptance of retaining-fees, which certainly can but place the 
witness, who accepts such fees, in the position of a partisan. 

The whole report deserves careful reading and will serve to 
define clearly the position of the American Medico-Psychological 
Association upon the question. 



Booh lReview0. 



Report of an Epidemic of Bacillary Dysentery at the Danvcrs State Hos- 
pital, Massachusetts, 1908. From the Laboratory of the Danvers State 
Hospital, Hathorne, Massachusetts. (Boston: D. C. Heath & Co., 
1909.) 

A study of an epidemic of bacillary dysentery which occurred during the 
summer of 1908 at the Danvers State Hospital, Massachusetts, has recently 
appeared. 

It is possible in a large and well-managed institution, such as the Dan- 
vers State Hospital, to weigh more accurately the various factors which 
have been thought to play a part in the etiology of bacillary dysentery 
than can be done through the study of a disease in a larger and less limited 
community. In this investigation the regular staff of the asylum was 
increased by a number of specially trained workers from the Harvard 
Medical School. The whole subject is presented in several divisions, some 
of which have unusual interest. 

The first comprises a statistical report of the epidemic. There were 1592 
persons in the institution, including 1400 patients, 192 servants, attendants, 
nurses and physicians, during the summer under consideration. The epi- 
demic began early in July, continued through August, and rapidly declined 
in September. There were in all 156 cases of dysentery, with 36 deaths, a 
mortality of 23.1 per cent. The cases were distributed pretty generally 
throughout all the wards of the hospital. Both sexes were about equally 
affected, although the mortality was naturally greatest among the weaker 
and bed-ridden patients. The duration of the disease varied from three 
or four days to two months, the average being about 12 days. 

In the second division of the study the various possible and probable 
sources of infection are considered. This is, perhaps, the most valuable 
portion of the study. It is thought that the disease was probably not water- 
born, because the water-supply was unusually good, and the number of 
cases of dysentery in the town of Danvers, using the same water, was not 
increased over the average. The milk-supply as a source of infection, was 
eliminated, as the milk was found on examination to be of unusual purity, 
and there was no difference in the incidence of the disease between pa- 
tients using milk and those not using it. The food-supply could hardly be 
the cause of the epidemic, as the same vegetables were supplied to a colony 
outside the asylum where the mortality from dysentery was practically nil. 
The possibility of the organisms being present in the sub-soil and being lib- 
erated by disturbance of it was also considered, but it was thought unlikely 
that this agency could have had much or any influence in causing the dis- 



I9IO] BOOK REVIEWS I93 

ease, as it happened that the wards where the disease was lightest were near 
where the most trenching had been done and that the part of the grounds 
where the soil had not been turned was farthest away from the wards 
where the disease was most severe. 

Two sources of infection were possible: One, a carrier of the disease 
introduced into the institution from without. A patient, who had prob- 
ably recently suffered from dysentery, was admitted in June, became ill 
again with dysentery early in July, and died July 10. Secondly, intra- 
mural carriers are possible. Undoubtedly, there were occasional cases of 
dysentery in the asylum throughout the year. The epidemic, from either 
of these sources, may have developed under favorable conditions. The 
chief of these conditions seem to be: i, hot weather; 2, house flies. 
Humidity, they believe, was not a factor. Hot weather favors the spread 
of dysenterj' because the viability of the bacillus is greater at this time and 
the number of flies is increased. Flies were particularly numerous in the 
institution during the height of the epidemic. These had access to the 
stools of the patients and also to their food, and in the opinion of the 
observers they were the most important factor in the spread' of this 
epidemic. 

Careful and systematic bacteriological investigations by the most ap- 
proved methods were made of the stools of 17 typical cases. In 14 of these 
the dysentery bacillus of the original or Shiga type was isolated. The same 
organism was obtained from one out of five autopsy cases examined. The 
examination of the blood and cerebro-spinal fluid in three cases proved 
negative. The authors are of the opinion, therefore, that the prevailing 
organism of the Danvers epidemic was of the so-called Shiga type, and 
not one of the closely-associated mannite-fermenting bacilli. The sera of a 
large series, 115 dysentery patients, were tested for agglutination with 
stock cultures of the Shiga and' Flexner-Harris types of bacillus dysen- 
teriae. Eighty-one per cent of these sera gave positive agglutination reac- 
tions in the sense that they reacted with Shiga in 32 cases, with Flexner- 
Harris in 37 cases, or with both in 24 cases. Nineteen per cent, or 22 
cases, were negative. Shiga agglutinations seemed to be more numerous 
at the height of the epidemic, while Flexner-Harris bacilli were more apt 
to be agglutinated over longer periods. It is suggested that the latter 
organism may be an occasional normal inhabitant of the intestinal tract. 

A study of the leucocytes showed an initial increase in the total number 
until the fifth day when the normal limit was reached. The proportion of 
lymphocytes was slightly higher than normal from the fifth to the tenth 
day of the disease. 

Pathology. — Careful pathological studies conducted in the fatal cases 
showed that the lesions found in the various organs other than the intes- 
tines could not be directly attributed to dysentery infection ; the intestines 
were always somewhat congested and swollen, the large intestine being 
particularly affected. The minute points of hemorrhage noted were not 
associated with ulceration. Ulcers were present in about one-half of the 



194 BOOK REVIEWS [July 

cases. Pseudo-membrane was found in about one-fourth of the cases 
examined. The most interesting pathological finding was the presence of 
minute thromboses of the small lymph and blood-vessels in the mucosa and 
sub-mucosa. This is due, the authors consider, to a primary necrosis of 
the endothelium produced by an absorption of toxin, either directly through 
the lumen or through the blood or lymph channels. Throughout the swollen 
mucous membrane a marked increase in fibrin formation was demonstrated. 
Clumps of bacteria similar to dysentery bacilli were found in the lumen of 
many of the infected vessels. They consider that the thrombosis with its 
secondary inflammatory changes may be the beginning of the intestinal 
ulceration. As the result of an attempt to correlate the clinical findings with 
the intestinal lesions, they conclude that a week is necessary for the 
production of ulceration, and after three weeks there is a tendency to 
heal. Pseudo-membrane formation may occur in eight to fourteen days. 
The toxaemic cases were more frequent in July, the ulcerative cases later in 
the summer. The mesenteric lymph glands were generally enlarged. These 
findings in general correspond closely to the pathological changes occur- 
ring in dyscnteria infantum. Special investigation was made of the nervous 
system in a number of cases, but no definite association could be traced 
between the nervous lesions and the dysentery infection. 

Prophylaxis. — A number of important prophylactic measures are sug- 
gested as a means of checking the disease. Among these may be men- 
tioned the isolation of the patient not only during the disease, but after 
recovery, or until the organisms are absent from the excreta ; through the 
immediate disinfection of all excreta and soiled linen, efficient screening of 
the sick-room, kitchen and dining room, the removal of the common breed- 
ing places of flies, such as rubbish heaps and open privies, and the provid- 
ing of special closed receptacles for manure and garbage. 

The several workers who have united in the report of the Danvers 
epidemic can certainly have the satisfaction of knowing that they have 
produced one of the most valuable contributions to our knowledge of this 
devastating epidemic. A fairly complete bibliography is appended. 

J. H. M. Knox, Jr. 

Die IVassermannsche Serodiagnostik der Syphilis in Ihrer Anwendung 
auf die Psychiatric. Von Dr. Med. Felix Plaut. (Jena: Verlag von 
Gustav Fischer, 1909.) 

The importance of the Wassermann reaction is being gradually recognized 
by the profession. It has rendered a great service to Neurology and 
Psychiatry and by this method we were enabled to settle the mooted 
question of the etiology of general paralysis and tabes. Furthermore, we 
are able to recognize the early stages of cerebro-spinal syphilis and differ- 
entiate it from obscure nervous conditions and brain tumors. 

Dr. Plaut, a pupil of Wassermann, and one of the early pioneers in this 
line of work, has written an admirable book which contains an excellent 
summary of serum-diagnosis of syphilis and its relation to psychiatry, 



igio] BOOK REVIEWS I95 

results of his own personal investigations which he carried on in Berlin 
(under Wassermann) and Munich, and a complete account of the litera- 
ture. The book is divided into seven chapters. 

In the first chapter he gives a historical retrospect of the development 
and nature of serum diagnosis in syphilis. Plant maintains that at present 
we are not in a position to explain the true biological significance of 
Wassermann reaction but offers the following conclusions: "(i) The 
Wassermann reaction for syphilis is a biologic specific antigen-antibody 
reaction ; on the one hand the. antibody has the peculiarity of reacting 
not only with the syphilitic antigen, but also with normal connective tissue 
constituents, and on the other hand, the antigen is closely related to lipoid 
substances or is a specific albumin-lipoid combination. (2) The active 
substances of the syphilitic serum are not antibodies, but are substances 
which owe their origin to syphilitic infection and possess a chemical affinity 
for lipoids (toxins?). (3) In the Wassermann reaction specific and non- 
specific combination-processes go hand in hand." 

In the second chapter he deals with the employment of the various 
methods in practice. The author adheres to the original Wassermann's 
test — using aqueous syphilitic liver extract as antigen, guinea-pig serum 
as complement, and artificial hemolytic rabbit's serum. 

In the third chapter he discusses in detail the technic of the Wassermann 
reaction. 

The fourth chapter contains a brief discourse on the clinical specificity 
of the reaction and declares most emphatically that the Wassermann test 
is only pathognomonic of syphilis and doubts the reliability of the results 
of those investigators who reported cases of scarlet fever, tuberculosis 
and other infectious diseases with a positive Wassermann reaction. 
Wassermann examined one thousand and ten persons without syphilis 
but they were afflicted with other diseases, such as, tuberculosis, pneu- 
monia, typhoid fever, or other infectious conditions, and indeed, in all of 
them the reaction was found negative. Likewise Plant's 126 cases gave 
similar results, save in five the reaction was positive, but in none of them 
could a previous history of syphilis be satisfactorily eliminated. Of seven 
children who have sufi'ered from scarlet fever, only one gave a positive 
reaction, but in this case hereditary syphilis was demonstrable. 

In the fifth chapter Plant embodies the results of his own clinical investi- 
gations which are extremely interesting and instructive. The cases selected 
for study were general paralysis, cerebral syphilis, tabes, tabes with a 
psychosis and mental enfeeblement on hereditary syphilitic basis. The 
material of general paralysis consisted of 153 cases — 107 men and 46 
women ; a luetic history was obtained in 78 and 58 per cent respectively. 
In all of them the serum gave a positive reaction ; in 147 cases the cerebro- 
spinal fluid was examined; in two the reaction was doubtful and in six 
negative (in these the serum was positive). Upon the strength of these 
results Plant asserts that syphilis is the cause of general paralysis and that 
every paretic is still syphilitic. 

In cerebral syphilis the serum is positive and the cerebro-spinal fluid, 



196 BOOK REVIEWS [July 

as a rule, is found negative. The author regards this an important diag- 
nostic point in the differentiation of general paralysis from cerebral lues. 
Eighteen cases of cerebro-spinal syphilis were examined ; they may be 
divided into three main groups — (i) 14 cases with a negative reaction of 
spinal fluid but a positive serum reaction ; (2) three cases with a positive 
reaction of both serum and spinal fluid; (3) one case in which the cerebro- 
spinal fluid and serum were negative. Plaut has not met any cases in which 
spinal fluid was positive and serum negative. 

Only 16 tabetics were examined and the majority of them were in the 
incipient stage of the disease. In six the spinal fluid reacted positively, 
one slightly positive (questionable) and three negative; the serum was 
positive in eight and negative in two. Only in one instance the spinal 
fluid alone was examined and was positive; in four cases the serum alone 
was examined and only one of them was negative. These results teach 
us that tabes like general paralysis is of a syphilitic genesis. 

A very important and interesting chapter is devoted to various forms of 
mental enfeeblement in childhood in which the hereditary syphilitic taint 
played an important role in the etiology. Fifty-eight children were exam- 
ined ; in 48 the serum alone was tested, in six both serum and spinal fluid 
and in four the spinal fluid alone was examined. They may be tabulated 
as follows : 



Diagnosis. 



TABLE. 

Spinal Fluid. Serum. 



Positive. Negative. Positive. Negative. 

Lues (not cerebral) sec. Manifestat. ... 2 

Lues (not cereb.) Ill lat . . 2 

Progressive Paralysis 4 . . 3 

Progressive enfeeblement not paretic. .. .. 2 

Inact. Pupil, without psychic disturb. . . . . I 

Inact. pupils with enfeeblement . . 2 

Enfeeblement with motor disturb- 
ances . . 2 

Enfeeblement without somatic dis- 
turbances . . 5 4 

Hemiplegia without enfeeblement .. .. I 

Meningococco. meningitis luetic 

Manifest. (Hered.) 2 

Acute cerebral lues 2 . . I 

Hydrocephalus . . I 2 

Nervous . . 2 7 

Degenerates . . 2 I 

Healthy . . . . 14 

6 4 23 29 

10 52 



IQIO] BOOK REVIEWS 19/ 

Plaut examined the serum of a whole family with the following results : 
Members of Family. Results of Examination. 

Husband denies syphilis. Not examined. 

Wife denies syphilis. Serum positive. 

Children. 
I. Son, set. i8, aparently well. Not examined. 

2-4. Miscarriages in the 6th month. 

5. Ludwig, Juv. G. P. Spinal fluid and serum positive. 

6. Premature birth in the 7th month. 

Died 6 mos. after birth. 

7. Joseph, aet. 11, stationary demen- Spinal fluid neg., serum positive. 

tia. 

8. Kate, aet. Syi, nervous, otherwise Serum neg. 

well. 

9. Otto, xt 6H. imbecile, nervous. Serum positive. 
10. Mary, xt. 3'/4, luetic exemth. at Serum positive. 

6 months. 

In the sixth chapter he discusses the influence of the Wassermann reac- 
tion during the course of the disease and on the mercurial cure and accord- 
ing to his own investigations specific treatment in paresis produces no 
effect on the Wassermann reaction. 

In the seventh chapter a comparative serological and cytological investi- 
gation is given, 

Plaut has dedicated an important book to Neurology and Psychiatry, 
and its value cannot be too highly lauded. It is a pleasure to note that 
Plant's book has been selected for a translation by the editors of the 
Nervous and Mental Disease series and, indeed, they are to be congratu- 
lated upon such a splendid choice. 

Morris J. Karpas, M. D., 

Ward's Island, New York. 

Seventeenth Annual Report of the State Charities Aid Association to the 
State Commission in Lunacy. Nov. i, 1908. (New York: United 
Charities Building.) 
This report shows that upon October I, 1909, there were in the State 
hospitals and licensed private asylums of the State of New York 31,541 
insane persons, an increase of 1.034 since the report of the previous year. 
Of this number 1127 were criminal insane at Matteawan and Dannemora 
and 1052 were the inmates of 24 licensed private asylums. This increase 
in the number of insane during the year leads the State Qiarities Aid Asso- 
ciation to suggest the wisdom of a wise forethought on the part of the 
State in making proper provision for an inevitable increase in the number 
of patients during a period of five years, rather than to provide each year 
for an actual increase after it has occurred. Including the overcrowding 
existing at present as estimated by the Commission in Lunacy and the prob- 

14 



198 BOOK REVIEWS [July 

able increase of patients between October i, 1909, and October i, 1914, the 
conclusion is reached that 6719 persons additional will need to be taken 
care of during the five years' period mentioned. To meet this urgent 
demand, besides the accommodations for 1754 patients already arranged 
for by appropriations they recommend hospitals for 600 acute cases, cot- 
tages and pavilions for about 300 chronic, disturbed or tuberculous pa- 
tients and rooms for 300 patients besides, in apartments to be vacated in 
consequence of the erection of separate quarters for physicians, nurses and 
other officers and employes, a total of 1200 patients more. This number 
(2954) is wisely thought to be the limit of expansion on the grounds of 
existing State hospitals. They, accordingly, recommend the building of a 
reception hospital in the City of New York to accommodate 200 patients. 
To give provision for the remainder two additional buildings should be 
erected, one in Westchester County to accommodate 2000 patients and the 
other in Rockland County or on Long Island. To build these hospitals 
for acute cases, cottages for chronic cases and additional homes for officers 
and employes ; to enlarge service plants and to acquire additional land ; 
and to erect new buildings on Ward's Island and in connection with the 
Long Island State Hospital, a reception hospital in New York City and 
two new institutions on new sites will require $7,474,325, an outlay which 
any State less wealthy than New York might contemplate with a heavy 
heart. That it is the wisest and cheapest for the State ultimately no one 
can doubt. 

The section of the report which deals with the occupation and entertain- 
ment of insane patients is of unusual interest. The value of employment 
and diversion as a therapeutic measure is emphasized rather than any con- 
siderations of the monetary value of the labor performed. Occupation and 
diversion help both body and mind and thus promote recovery. In less 
hopeful cases these agencies arrest the tendency to mental deterioration and 
often bring about an improvement in condition which permits the chronic 
patient to live outside the State hospital. The establishment of courses 
for the instruction of nurses and attendants in methods of interesting their 
patients in those occupations and amusements which are found to best 
promote recovery is also urged in connection with the School of Phil- 
anthropy in New York. 

An equally interesting section of the report treats of the proper care of 
the alleged insane pending their commitment and a plea is made for the 
transfer of the powers and duties connected with the detention and com- 
mitment of the insane from the poor-law officers to the health officers. 
The connection of the poor-law officials with the insane is a remnant of 
the old system of local care of the pauper insane in almshouses at a time 
when there was no other provision for the care of insane persons. The 
care of the insane has now become a health question and it is important 
that there be no delays or mistakes in the treatment of the insane in the 
early and curable stages of their malady. It is pointed out also that if the 
medical care of the insane pending commitment were given to health 



igio] BOOK REVIEWS I99 

officers it would give a large and active body of medical men a valuable 
experience in this heretofore neglected class of diseases and help to edu- 
cate the public. Above all such removal from the custody of officials of the 
poor would bring about a great improvement in the attitude of the public 
towards the insane by severing the present unnatural association of in- 
sanity with pauperism. 

The report of the Sub-Committee on Prevention and After-Care, which 
is included in this report, contains much valuable food for thought of 
which our space will not permit a more detailed mention. It seems un- 
fortunate that so few State institutions co-operate with this sub-committee 
and as has occurred before in the history of this sort of philanthropy the 
work continues personal and local rather than State-wide and systematic. 
Much remains to be done to make the movement more efficient. 

The reports of visitors to State hospitals are more than usually complete 
and we may add sensible. There is a conspicuous absence of those fan- 
tastic and sensational recommendations which often characterize the activi- 
ties of amateur philanthropists. These visitors show a familiarity with the 
conditions which they have been visiting and commend or criticize with an 
evident knowledge of the situation. The appendix of the report gives 
useful suggestions to visitors to State hospitals for the insane which ought 
to be brought to the attention of all persons visiting institutions in a simi- 
lar capacity in other States. The matter, manner of presentation and 
general spirit of the work of the State Charities Aid Association are 
admirable. 

Expansion of Races. By Charles Ed\v.\rd Woodruff, A. M., M. D. (New 
• York: Rebman Company, 1909.) 

There are certain books of which it may be said that they represent more 
the author than the subject. And this need not be to their discredit. An 
opinionated book has at least a spine to it and animation; whatever its 
mode of progression at least it attempts to get somewhere. For those who 
are both learning and thinking it has charms lacking to a more balanced 
literature. 

Colonel Woodruff's " Expansion of Races " is such a book. Under this 
title one finds an anthropological study, a very sturdy and interesting one, 
in justification of the policy of imperialism. The author attacks many prob- 
lems by the way, on some of which, as, for example, the effect of the tropics 
on white races, he has a very special knowledge. The treatment of the 
negro problem is worthy of attention ; and Colonel Woodruff's views on 
many other things — on " Christianity and Democracy," on commercialism, 
on the matter of a Filipino part of the regular army, on further diverse 
subjects — are ably put. 

The book opens with the thesis that population acts as a fluid, and this 
simile is elaborated to the very last tip of its numerous ramifications. The 
" Saturation Point of Populations," the " Evils of Undersaturation and 
Supersaturation," the behavior of streams of migration are treated in 



200 BOOK REVIEWS [Julv 

much pertinent detail. But the simile has led its artificer into a snare now 
and then. Witness the following : 

" The soil cannot possibly hold all the rain poured upon it. Some must 
run off or be evaporated after collecting into pools, nor in like manner can 
the surface hold the rain of babies poured upon it. They, too, collect in 
pools of humanity to be evaporated by death, or they must flow off in 
migrating streams as soon as able." 

Though grotesque, this figure expresses well the reasoning upon which 
the author justifies our policy of "expansion," as it is so often discreetly 
termed. He suggests indeed that we have an economic right to Haiti and 
the Central American countries. As he phrases it, " Imperialism is com- 
mercialism." 

In the chapter growing from this idea one finds a discussion of the 
proper diet for white men in the tropics, on tropical neurassthenia, and on 
the " myth of acclimatization." Then one passes to a broad consideration 
of various civilizations, of democracies, of " the unnatural democracy of 
America," and, finally, of the future democracy. The statistics furnished 
are usually convincing and always seductive. The author, too, has a wide 
command of authorities. 

It is difficult in another way than by that of enumeration to give an 
idea of the book's scope. Many problems of the races of man are juxta- 
posed that have little essential connection. The treatise is a unit only in 
so much as it is an attempt to turn anthropology to our American uses. 
But the many topics are strikingly handled. The author believes (among 
other things) that there can be no fusion of the negro and white races in 
this country, that hybrid races are always weak, that acclimatization is a 
myth, that education cannot improve the intelligence, that socialism is in- 
evitable. These views are worthy of consideration though one may dissent 
from them. Perhaps not a few readers will have the experience of the 
present critic. He took up the " Expansion of Races " to review it for a 
journal, but ended by reading it for himself. 

The volume, as a specimen of book-making, is an agreeable one. 

Modern Clinical Medicine: Diseases of the Nervous System. Edited by 
Archibald Church, M. D. An authorized translation from " Die 
Deutsche Klinik," under the general editorial supervision of Dr. 
Julius L. Salinger. (New York and London: D. Appleton & Co., 
1908.) 

We know of no recent work on diseases of the nervous system which so 
thoroughly meets at once the wants of the general practitioner and the 
requirements of the specialist, as does this work. 

The various divisions of the work differ in strength and value, as would 
naturally occur when written by so many different authors, but we can 
find no portion of the book which will not well repay careful reading and 
there are many of a very high order of merit. 

The contributors to the volume, without mentioning by any means all, 



igiOj BOOK REVIEWS 20I 

are such well-known authorities as Rosin, Ziehen, Schuster and Bernhardt, 
of Beriin ; Redlich, of Vienna; Quincke, of Kiel; Erb, of Heidelberg; 
Edinger, of Frankfort ; Eichhorst, of Zurich ; and Wernicke, of Breslau. 

The articles which will be read with perhaps the greatest interest by psy- 
chiatrists are those upon the Normal and Pathological Histology of the Ner- 
vous System, with special reference to the Neurone Theory (Rosin), Gen- 
eral Neurological Diagnoses (Redlich), Modern Aids to Diagnosis of Dis- 
eases of the Brain (Redlich), Lumbar Puncture (Quincke), The Symptom- 
Complex of Aphasia (Wernicke) and Hysteria (Ziehen). 

To properly review a work of this character would necessitate an analy- 
sis of each division of the work. The titles of the articles we have selected, 
with the names of their authors, will give the expectant reader some slight 
idea of what is here offered. 

We think the editor of the work is to be commended for presenting it 
to English readers, and that he is also to be commended for refraining 
from making any editorial additions or comments, which might, as is gen- 
erally the case with such addenda, to quote the editor, " confuse the medical 
reader by discussions of disputed and unessential features."' 

Eleventh Annual Report of the State Board of Insanity of the Com- 
mon-a'calth of Massachusetts for the year ending November 30, 1909. 
(Boston: Wright & Potter Printing Co., State Printers, igio.) 

The most interesting portion of this elaborate report of 290 pages is the 
section devoted to a resume of the proceedings at two semi-annual con- 
ferences between the Commissioners in Lunacy and the trustees and medi- 
cal officers of the different State institutions. At these conferences matters 
of practical importance seem to be dealt with and in addition to formal 
papers by the chief medical officers of the institutions represented there 
are full and free discussions participated in by all present. At the first 
conference " Precautions Against Ill-treatment of Patients in Institutions " 
were considered carefully and upon the whole judiciously, although some 
criticisms might be justified. It is evident from the discussion that many 
institutions have not yet established training schools for nurses, and that 
in the majority of institutions there is a modicum of instruction which 
hardly entitles the institution to the credit of having a school at all. One 
of the speakers, for example, said: "The persons (referring to nurses) 
need instruction. They cannot be expected to know their duties without 
patient and continued advice and instruction. They need to talk with the 
one who represents the management of the hospital and details of duty 
should be told over and over." This would seem to indicate that the 
standard of education is very low and scarcely above the education of the 
nurse for the insane forty years ago, when the newcomer was asked to 
read the " rule book," and was supposed to be thoroughly familiar with 
his duties as soon as he had finished the book. This standard seems in 
marked contrast to the conception of the education of a nurse which 
obtains at Danver's State Hospital as shown in the recent address of Dr. 



202 BOOK REVIEWS [Ju^.V 

Page. Massachusetts owes it to herself to establish a training school in 
each one of her institutions for the insane and should no longer be satis- 
fied with hap-hazard methods of instruction. 

At ihc second confcronce the matter of records was taken up and we are 
glad to observe that a uniform and satisfactory system of histories and 
records exists in all the State institutions. The use of the dictaphone in 
one of the hospitals would seem worthy of imitation by all. The discus- 
sion upon the correspondence of the insane revealed the surprising fact that 
the superintendent of a hospital or his assistants has no legal right to open 
any letter addressed to a patient to ascertain whether or not it may contain 
money, matches, morphine or fire-arms, but he could fail to deliver it and 
might in fact " supf>ress it and burn it up" If the right to suppress and 
burn actually exists it is to be hoped that a legal enactment may be found 
to justify such proceedings. 

It is interesting to note that the total number of different patients 
actually received in institutions during the year was 2954, a decrease of 
no compared with an increase of 328 the previous year. This seems en- 
couraging, but after all a twelve months period is too short a time to 
draw any very conclusive deductions. 

The appointment of such an energetic worker and accomplished scholar 
as Dr. E. E. Southard as State Pathologist marks a new era in the care 
of the insane in Massachusetts. His previous career justifies the highest 
hopes for the future. The State is most fortunate in getting his services. 

Traite International dc Psychologic pathologique. Dirccteur, Dn. A. Marie. 
Comite de Redaction, Bechterew, Clouston, Grasset, Lugaro, Magnan, 
Pilcz, Raymond, Ziehen. Tome premier, Psychopathologie generale, 
pp. viii-1028, with 353 illustrations. (Paris: Feli.x Alcan, 1910.) 

The value of composite treatises such as the present one is always a 
question for differing opinions. What one man cannot undertake single- 
handed is often somewhat disappointingly performed when various authori- 
ties unite in the collaboration. The disadvantages of such collaboration 
are self-evident and practically inevitable ; they must e'en be reckoned with. 

The present volume is divided into ten chapters. In the first (pp. 1-30') 
Grasset discusses the relation of psychiatry and neurology and the unity 
in methods and object of " human neurobiology." The field comprises con- 
scious (mental) and subconscious (automatic) psychic facts, 1. e., the 
superior and inferior psychism of Grasset. The soul, not being a scientific 
fact, is ignored. 

Grasset hastily reviews the well-known methods of study (symptomatic, 
pathologic, etiologic, localization), but without reference to the most im- 
portant of all, that of individual psychology and biogenesis. Neither is 
this subject considered in the later section on psychology (Bechterew), 
which deals with objective symptomatology and methods of examination. 

Under the sociologic relations of psychiatry, Grasset refers cursorily to 
the rights and duties of society, with regard not only to the actually 



igiO] BOOK REVIEWS 203 

alienated, but also to the "demifous," whose legal status he has recently 
treated monographically. His eugenics (a word, however, which he does 
not use) is confined to what may be spoken of as the stereotyped orthodox 
position — prohibition of marriage in mental cases, even though cured. He 
refuses to countenance the pragmatic suggestion (anticonceptional prophy- 
laxis) of more liberal authors. 

Chapter H is a wxll-documented and interesting article by Del Greco, 
dealing with mental disease historically, philosophically and critically. The 
chapter loses, perhaps, in effectiveness, however, and certainly in directness 
and unity, by the wide excursions into the whole fields of philosophy and 
natural science, which the author permits himself. The treatise is a broad 
and learned one which essays to show how through the evolution of ideas, 
the present science of psychiatry has come to its place in the realm of 
knowledge. 

A voluminous, amply illustrated article by A. Marie on psychiatric 
anthropology is followed by shorter chapters on the fissures and convolu- 
tions by Mingazzini, and the chemistry of the cerebral substance by A. 
Marie. 

Ne.xt are treated disorders of the bodily functions in mental disease (pp. 
3iS"4S7) by A. Marie and Dide, and pathologic anatomy and histologj' 
(pp. 459-708) by Klippel, Lugaro, Marinesco, Dide, Medea and Laignel- 
Lavastine. In the section on the Histologic Diagnosis of Mental Diseases, 
Lugaro offers brief but judicial consideration of the differing opinions of 
Flechsig and his opponents, notably Vogt and Brodmann, on the myelo- 
genetic theory; and also of Marie and his critics on the aphasia question. 
Particularly in the discussion of Flechsig's theory is exemplified the process 
by which the truth of scientific facts becomes established. A startling dis- 
covery is made. It is spread abroad with sensational effect. As a theory 
it finds ever widening application — it explains everything — becomes dogma. 
Exceptions are discovered — flaws brought to light in the theory — incom- 
patible facts come forward. The opposition grows — theory rejected alto- 
gether. Communal points appear between defenders and critics of the 
theory — some truth in it after all — modified position of both sides — each 
partly right — question of point of view, mode of attack, etc. — reconciliation 
— resultant appro.ximate truth established — all hands happy. 

Taking up the question of the anatomic basis of consciousness, Lugaro 
sets out with the conceptions of Tanzi, upon which he elaborates. " Every 
psychic phenomenon is presented to us as a phenomenon of consciousness 
and at the same time as an affect state .... the former is particularly 
associated with morphologic conditions and develops among the central 
terminals of the afferent fibers, and is, therefore, interneuronic; the latter 
is particularly associated with dynamic, nutritive and chemical states which 
develop within the cell bodies, and is consequently intraneuronic." Thus 
is explained the relative differences in stability of intellective and affective 
events. 

Lugaro discusses the general pathology of the essential cortical elements. 



204 BOOK REVIEWS [Julv 

nerve cells, neuroglia, vascular elements, but without detail. His " ana- 
tomic syndromes " are confined to the well-known limits — comprising the 
various gross lesions; developmental anomalies such as infantile gliosis; 
arteriosclerotic and senile dementia ; paresis ; toxic, exhaustive and inflam- 
matory states, and primary neuronic degenerations, such as amaurotic 
family idiocy. Dementia praecox is classed as a primary neuronic degene- 
ration. The gloomy outlook for the pathology of the great mass of psy- 
choses and psychotic states, represented partially by the so-called " func- 
tional psychoses " is frankly met. In such cases " the search for anatomic 
lesions must appear not merely as a desperate undertaking, but still more 
as unjustifiable labor." 

Marro writes (pp. 709-814) of the psychologic development at puberty, 
passing in review the varied abnormal mental states and diseases which 
are associated in one way or another with this period of life. The article 
includes a discussion of puberty and crime, and the psychology of homicide. 

Clouston affords a comfortable talk on the general methods of clinical 
examination. The article is somewhat the worse from the proof-reader's 
neglect. In discussing the character of the voice, the author is made to 
say that the ideal woman should have one " ever soft, gentle and lord, an 
excellent thing in woomen." 

The volume closes with sections by Bechterew on the objective psycho- 
logic examination of patients ; by Ferrari on the medico-psychologic 
examination of defective children ; and by Carrarra on the examination of 
the criminal insane. 

Two other volumes are to complete the series. Volume II is the clinical 
volume, while Volume III covers the broad field of therapeutics and insti- 
tutional care and management. Farrar. 

Reports from the Pathological Laboratory of the Lunacy Department. 
New South Wales Government. Vol. IT, Part i. Published by 
authority of the Government of the State of New South Wales. 
(Sidney: William Applegate GuUick, Government Printer, 1910.) 

This volume of 1 12 pages contains the following papers : The Pa- 
thology of General Paralysis of the Insane, with special reference to the 
action of Diptheroid Organisms, by J. Froude Flashman and Oliver 
Latham ; The Method of Diagnosis by Means of Complement Fixation, 
as applied to Syphilis and General Paralysis : The Wasserman Reaction, 
by J. Froude Flashman and A. Graham Butler ; Note on the Cerebro- 
spinal Fluid in General Paralysis of the Insane, by Thos. C. Parkinson; 
Demonstration in Freezing Histological Methods, by Oliver Latham; A 
case, of Cervico-brachial Neuritis, by C. A. Hogg; Dysenterj' in Hospital 
for Insane, Parametta, by G. Prior; Degenerations following resection of 
Olfactory Lobe in Dasyurus Viverrinus, by J. Froude Flashman. 

The papers are all good and will repay reading by those interested in 
the alx)ve subjects. Dr. Flashman who is Medical Superintendent of the 
Pathological Laboratories is to be congratulated on the work done under 
his direction. W. R. D. 



I9IO] BOOK REVIEWS 2O5 

A Text-book of Mental Diseases. By Eugenio Tanzi, Professor of Psy- 
chiatry- in Florence. Authorized translation by W. Ford Robertson, 
M. D., etc., and T. C. Mackenzie. M. D., etc. Royal octavo, pp. XVI 
to 803. Illustrated. (London: Rebman, Limited, 1909.) 

Tanzi's excellent treatise has the distinguishing virtue of comprehending 
a subject, selecting essentials, and saying much about them in little, without 
the sacrifice of clearness. 

Beginning with a discussion of the seat of the psychical processes, he 
points out the ultimate futility of a long array of external etiologic facts, 
as well as of an elaborate descriptive symptomatology, without the attempt 
to capture that elusive tcrtittm quid, the pathogenic element. It is easy to 
collect causes, it is not difficult to observe subsequent symptoms, but how 
did they come about? The why is another question which may reasonably 
wait until the hoiv is settled. This is the focal point in present-day psy- 
chiatric analysis. 

Tanzi's conception of anatomic localization is elucidated in a few brief 
paragraphs. He indicates the contrast between bilateral sensory centers, 
corresponding with the two sides of the body and the double supply of 
special sensory end organs, and the unilateral sites of symbolic representa- 
tion, which answer to no such peripheral reduplication, and in which the 
unity of psychic phenomena requires no symmetrical cortical localization. 
Thus the existence of specific psychic centers is placed beyond peradven- 
ture, but with qualifications which Tanzi thus expresses : " The psychical 
centers do not contain ideas, but the ingredients of ideas, or, better still, 
they have the capacity of producing the ingredients that serve to compose 
the ideas or to symbolize them ; and the physiologic division between center 
and center does not correspond to categories of ideas, but to categories of 

ingredients, or of symbols The law that the functional processes are 

always pluriccUuIar also holds, however, for these centers, as does also the 
law that every cell has the power of resisting or yielding to stimuli, and of 
reacting in various though similar ways. Further, the activity of a single 
cell never corresponds to an imaginable figure, whether it be of the most 
elementary or of the most vaguely symbolic nature, unless it is compounded 
with that of very many other cells, perhaps thousands, scattered here and 
there in the brain." 

The consideration of the causes of mental disease, as thus far discernible, 
is gratifyingly condensed in twenty-eight pages. The student is spared the 
stereotyped statistics, and elaborate conventional discussions of climate, 
race, season, occupation, etc., which though requisite in the encyclopedic 
treatise, seem often enough to be the expression of a sort of text-book 
habit, which may leave much to be desired. 

Tanzi shows that the nerve element itself is hardly subject to fatigue, 
and that the only psychic events which may primarily do harm are the 
emotions. This is so because of the widespread visceral disturbances asso- 
ciated with emotional states, and which determine metabolic disorders and 
contribute to the blood autotoxines, which, by reason of its delicate 



2o6 BOOK REVIEWS [July 

organization, appear to have a selective action upon the brain. " This is 
the only waj' in which mental diseases can have a strictly psychic origin." 
The first third of the book comprises, in addition to the sections already 
discussed, chapters on the general pathologic anatomy of the brain, and 
pathologic psychology. The latter is divided into sections on Sensibility, 
Ideation, Memory, the Sentiments, Movements and Other External Reac- 
tions, in each case the consideration of the morbid processes being preceded 
by a few introductory pages on the normal psychology. These introduc- 
tions are designedly elementary and well adapted to the needs of the 
student. At the same time the chapters are adequate, lucid and direct, and 
well rendered in the translation. 

The classification of mental diseases is allowed a separate chapter (pp. 
261-285), in which the author reviews the groupings of Esquirol, Griesin- 
ger, Guislain, Morel, Krafft-Ebing, Verga, Morselli and Kraepelin. His 
own classification, followed in the clinical section (pp. 286-771), is as 
follows : 

I. Poisonings : 

(l) Pellagra, (2) alcoholism, (3) morphinism, cocainism. 
11. Toxic infections and autointoxications: 

(t) Amentia (including acute delirium), (2) uraemic psychoses, 
(3) thyroid psychoses, (4) paresis. 

III. Encephalopathies: 

(i) Infantile cerebropathy, (2) adult cerebropathies (tumors 
trauma, syphilis, arteriosclerosis, senile dementia). 

IV. Affective psychoses : 

(i) Mania, (2) melancholia, (3) circular psychoses. 
V. Constitutional neuropsychoses : 

(l) Neurasthenia, (2) hysteria, (3) epilepsy. 
VI. Dementia praecox : 

(i) Hebephrenia. (2) katatonia, (3) paranoid. 
VII. Degenerative mental anomalies: 

(l) Sexual perversion, (2) constitutional immorality, (3) par- 
anoia, (4) intellectual feebleness (hereditary imbecility). 
In this scheme the author attempts to follow a progressive course from 
purely or predominatingly exogenic mental disorders to those predominat- 
inly or essentially endogenic. There is thus a double appropriateness in 
opening the clinical section with Pellagra, to which twenty-three pages are 
devoted. 

In classification Tanzi follows in general the etiologic-clinical method 
just as does Kraepelin. His scheme is, however, much simpler, and on 
this account, necessarily less open to dispute. He does not distinguish 
between exhaustive and infective psychoses clinically. All of these which 
follow an acute course he puts together as Amentia, believing the toxic or 
infective agent to be the prime etiologic factor. Even the cases in which 
there is palpable organic exhaustion, suffer in consequence metabolic dis- 
orders, the expression of which is an autotoxic state which may show itself 
characteristically as an abnormal mental condition — amentia. 



igiO] BOOK REVIEWS 207 

At the other end of Kraepelin's scheme, among the congenital psychop- 
athies so-called, Tanzi also finds grounds for criticism. He considers so 
many subdivisions superfluous, e. g., between original neurasthenia and the 
obsessional and impulsive states, all of which he believes represent merely 
three grades of one process, thus approximating in his conception the 
original thesis of Beard. 

Tanzi makes the familiar objection to the maniaco-depressive insanity of 
Kraepelin, that it destroys the integrity of the so-called simple manias and 
melancholias. The result must be, he gloomily predicts, " that, after a cen- 
tury of recognition, melancholia will shrink into the obscurity of a poorly 
defined involutional form, and mania will disappear altogether from the 
list of independent mental diseases. On the ruins of their syndromes 
there will be raised on the one hand a too widely extended conception of 
dementia prxcox, and on the other of a new disease of doubtful nature and 
very varied in its manifestations — maniaco-depressive insanity." If the 
outlook was unhappy when this was written, it must be still more so now, 
for in the interim, even the involutional melancholia has been stripped of its 
identity by the Kraepelin school. 

That the tendency has been to extend the Kraepelin syntheses to unwar- 
ranted extremes there can be no doubt, but this is entirely in accord with 
the pendulum movement of any new idea which engages wide attention. 
On etiologic and prognostic grounds it may well be held erroneous to con- 
found all possible phases of maniac excitement and melancholic depression, 
if by this procedure the resultant synthesis becomes practically a chronic 
degenerative psychosis, of which folie circulaire or cyclothymia is the type. 
In this way altogether too many simple cases of excitement or depression, 
often clearly reactive in character, are calmly foredoomed to hypothetical 
recurrences and alternate attacks, where there is no more reason, so far as 
we know, for such a sinister prophecy, than there would be in saying that 
the man who has once broken his leg, is a candidate for breaking the same 
leg again, and perhaps again, or else the other leg. The tendency among 
alienists to look at the affect psychoses in this way is dangerous. The 
beliefs of the specialist to-day are the beliefs of the family physician 
to-morrow, and of the laity the day after. Thus may habits of thought be 
engendered which hereafter might assume the baneful importance of 
etiologic factors. 

On the other hand, it must be admitted that definite symptomatic criteria 
have not yet been forthcoming to forecast the life course from the indi- 
vidual attack. Perhaps such an act of sheer prophecy should not be 
expected, even of psychiatry. Kraepelin challenges any alienist to say 
from the symptom-picture alone, whether he is dealing with a case of simple 
mania, periodic mania or circular insanity. Tanzi admits that it cannot be 
done. Whether or not the future may afford aid in this dilemma, the fact 
remains that in the present uncertainty there is no more justice in assum- 
ing that every first attack presages recurrence or periodicity — as by the law 
of probabilities a certain number of recurrences will take place — thus over- 



2o8 BOOK REVIEWS [July 

shadowing every patient with a dubious future and seeing in his illness only 
a partial manifestation of a deep-lying constitutional malady — in this atti- 
tude there is no more justice than in its antithesis, which recognizes only 
a succession of accidental attacks of the same or of a contrasting disease. 
This by the way. 

Tanzi's arguments against the Kraepelinian viewpoint, it must be con- 
ceded, are not very convincing; and yet his protest, like many another to 
the same purpose, impresses one as a not unwholesome counterpoise to an 
extreme tendency in many quarters, which perhaps even oversteps the 
limits of Kraepelin's own position. 

The text-book of Tanzi may be commended for its originality and lucid 
description, although it wants the searching clinical analysis and the refine- 
ment of clinical variety one is used to in Kraepelin. One is somewhat 
startled to behold the confines of amentia enlarged away beyond those of 
mania, although it is to be remembered that under amentia are grouped 
most of the infective, toxic and exhaustive states. Dementia prsecox 
Tanzi reckons at at least 25 per cent of hospital admissions, certainly a high 
figure. 

A chapter on asylums and institutional care closes the work. 

Farrar. 

Collected Papers, 19OQ. Department of Neuropathology, Harvard Univer- 
sity Medical School. 
This is a paper-bound collection of si.x papers which appeared during 
igog, in various medical periodicals, the authors being Drs. E. E. Southard, 
Henry A. Cotton, F. P. Gay, J. G. Fitz-Gerald, C. T. Ryder, E. T. F. 
Richards, A. H. Peabody, M. M. Canavan, C. T. McGaffin, and J. J. Put- 
nam. As an introduction there is a brief note concerning the establish- 
ment of the Bullard Professorship of Neuropathology, which chair is 
filled by Dr. Southard. It is needless to say that the papers are interest- 
ing and that it is convenient to have them in this form. W. R. D. 

Mortality Statistics, igo8. Ninth Annual Report. (Washington, Govern- 
ment Printing Office, igio.) 
This work is probably too well known to need any description. The 
statistics of those dying insane seem to be as full as is possible in the 
absence of any standard classification. W. R. D. 



abstracts an& leitracts. 



Uebcr Folic von Jugcndirrcsein ixi Kindesalter. VoN H. Vogt. Allge- 
meine Zeitschrift fiir Psychiatrie, Bd. 66, S. 542. 

The author's conckisions are : 

1. Even before the beginning of normal puberty there are disease con- 
ditions in childhood which from their symptoms, course, and whole 
character must be considered as early forms of adolescent insanity. 

2. In many cases it can be proved that there is an abnormally early 
puberty ; in other cases it is probable. The onset of these deep funda- 
mental changes, which the organism passes through at puberty, at an 
abnormally early time, or the reverse, points to the possibility of an affec- 
tion of the brain. 

3. Moreover, the early forms of adolescent insanity show catatonic, 
hebephrenic, and paranoid conditions. By far the most numerous are 
cases of the first, the last being naturally most infrequent. The frequency 
of catatonic symptoms in childhood is explained by the psychomotor 
condition of the child which renders it especially liable to such a complex. 
The later symptom-picture shows clearly the characteristic form of 
mental enfeeblement with the corresponding characteristics which are 
found in the content of the child psyche. 

'4. Many cases are grafted on an already existing condition of weak- 
mindedness, others have for a variable length of time previously shown 
peculiarities, characteristic mannerisms, etc. These last cases have often 
been recognized and worked over in school. Other cases occur in chil- 
dren who have previously been quite normal. 

5. Recovery may occur. The prognosis is uncertain. Remissions are 
numerous. Many cases recover partially, many become demented. Con- 
cerning the course of the early forms of adolescent insanity the funda- 
mental principles of Cramer are applicable. 

6. The differential diagnosis must be made from hysteria, increased 
muscle tone in indigestion, organic disease, or several other affections, 
especially cases of idiocy with catatonic symptoms. On the other hand 
it is possible for early cases of adolescent insanity which have been cured 
with some defect remaining to greatly resemble weakmindedness. When 
differentiation by the characteristic dementia is impossible, hte diagnosis 
must be made on the course, or accompanying symptoms. There are 
cases in which the differential diagnosis is doubtful. Some cases of de- 
mentia infantiles, for example, belong in the group of the early form of 
adolescent insanity. Others, however, represent another form of illness 
whose nature is as yet entirely unknown. W. R. D. 



2IO ABSTRACTS AND EXTRACTS [July 

Contributo alio studio delV anatomia patologica delta paralisi progres- 
siva: alterazioni viscerali. — Qualche consxderasione sulle plasmacel- 
lule. Per Guinio Catola. Rivista di Patologia nervosa e mentale, 
Vol. XV, p. I, Jan., igio. 

In comparison with the great amount of study which has been made 
of the nervous system in paresis, but httle has been done upon the other 
viscera. The purpose of this research is to investigate such changes in 
seven cases and the organs studied are the hver, spleen, kidneys, muscles, 
and peripheral arteries. Summaries of the results of nine other authors 
are given, after which each case is taken up in detail, a brief clinical 
history being followed by a more detailed report of the changes found in 
the organs above mentioned. The staining methods were the Unna-Pap- 
penheim, Unna-Taenzer. Van Giesen, Mann, Cajal's trichrome, and Flem- 
ming's fixation method for fatty degeneration. Two of the cases died 
in epileptiform attacks, two in apoplectiform attacks, and three from 
exhaustion. The various theories of the origin of plasma cells are then 
discussed and the presence of the same in cases of senile dementia, alco- 
holism, tabes dorsalis, Banti"s disease, and in six and seven months fae- 
tuses of syphilitic mothers. 

The following conclusions are then stated : 

1. In the viscera of paretics there may be found a series of vascular 
and perivascular changes (infiltration with lymphocytes and plasma cells), 
and of parenchymal changes (cloudy swelling, degenerations), similar 
in the main with those of the central nervous system, but which cannot 
be considered as essentially specific lesions of the disease in question. 
However, while the parenchymal lesions are not different from those 
which may be met with in any other dyscrasic or toxic state, the plasma 
cell, alone or accompanied by lymphocytes, may be compared in the 
various organs in quite different anatomo-pathologic contingence, and 
especially there may be an active phenomena, more or less evident, of 
connective hyperplasia. 

2. As in the brain, so in the viscera, and especially in the liver, the 
presence of lymphocytes and of plasma cells may make quite probable the 
diagnosis of progressive paralysis, when the infiltration of such elements 
is diffuse, in a more or less uniform manner, throughout the organ and 
when focal defect lesions (tumors, parasites, abscesses, etc.), or other 
lesions, or diffuse easily diagnosticated (tuberculosis, syphilis, cirrhosis, 
etc.), are lacking. In other words, organs which ordinarily do not con- 
tain plasma cells nor lymphocytes, as the liver and kidneys, when they 
are rich in such elements, without or almost without the concomitant phe- 
nomenon of cirrhosis, more or less recent, acquire all the probabilities of 
having belonged to a paretic. 

3. In none of the paretics examined have we met the histo-pathologic 
picture described by Klippel under the name of " vaso-paretic " liver. 

4. We have not observed a perceptible difference between the visceral 
lesions of paretics dying suddenly, while in a good condition of general 



igiO] ABSTRACTS AND EXTRACTS 211 

nutrition, by apoplectiform or epileptiform convulsion, and those of the 
viscera of paretics dying slowly and with bedsores of greater or lesser 
size, which would seem to be sufficient to produce the above-described 
changes, that is. the state of nietasyphilitic intoxication, or what consti- 
tutes the fundamental pathogenesis of progressive paralysis. 

5. The plasma cell shows, in the viscera that we have studied, a clear 
histogenic origin ; it may be proved that the cell comes from the con- 
nective. But we may be induced to admit in certain cases a hemato- 
genous origin if we wish to identify the plasma cell as the condition de- 
scribed by Unna and Marschalko with other elements that are modified 
through many morphologic characteristics and that by Hodara in a later 
condition called pseudo-plasma cell, cells that, in all probability are simply 
mononuclear leucocytes greatly modified in their staining reaction. 

W. R. D. 

A Cytoscopic Study of the Cerebrospinal Fluid in General Paresis. By 
Samuel Stern, M. D. New York Medical Journal, Vol. XCI, p. 909, 
April 30, 1910. 

The author states that " Heretofore it has been an accepted fact that in 
all metasyphilitic processes there occurred a lymphocytosis, and in many 

reports they were estimated by cubic millimeters It is e.xtremely 

doubtful ; in fact, at this time, I am almost prepared to say that lympho- 
cytosis does not exist as a normal or abnormal condition in the cerebro- 
spinal fluid. That which has been previously reported was most likely due 
to degenerative endothelial cells." Typical lymphocytes may be present, 
but when they are it is due to " a free hemorrhage into the spinal canal 
when the puncture is made, or a few minims of blood finds its way into the 
lumen of the needle, during its passage through the muscular structure 
necessary to reach the spinal canal." 

As a control to the cell morphology of both the lymphocytes and endo- 
thelial cells, the author has studied smears of fluid from the pleural cavity 
and has found that the morphology and degenerative changes were the 
same in the pleural fluid as the cells found in the spinal fluid. The con- 
trols showed the same character of cells, the same proportion of lympho- 
cytes as those demonstrated in general paresis, the only difference being 
the abundance of degenerative endothelial cells. It was noted that there 
appears to be a difference in the relative number of cells in the non-specific 
cases studied, with a tendency to a comparative increase in senility and 
uremia ; also, that in metasyphilitic diseases, cells were usually present 
without centrifugalization, while in the controls the cells were usually 
absent without centrifugalization. 

The presence of plates was found, as frequently occurs in desquamation 
of seroi:s and mucous membranes, and when the morphology of the single 
cells was compared with those appearing in plates, it was identical both in 
the cerebrospinal and the pleural fluid studied. The author has never seen, 
nor has he found any description of in literature, lymphocytes occurring 



212 ABSTRACTS AND EXTRACTS [Jul)' 

in plates. The subacute leptomeningitis which occurs in paresis accounts 
for the desquamation and degeneration of the endothehal cells, and thus 
for their presence and increase in number in the spinal cord. 

The technique employed was with from ten to fifteen cubic centimeters 
of fluid with the Wright and Leishman stains, and a one-twelfth oil immer- 
sion lens. 

In conclusion, the author states that he feels safe in declaring a case to 
be paresis, or tabes, upon the demonstration of a large number of endo- 
thelial cells upon centrifugalization, or the demonstration of endothelial 
cells without centrifugalization. 

W. R. D. 



Volume LXVII OCTOBER, 1910 No. 2 

AMERICAN 
JOURNAL OF INSANITY 

SUGGESTIONS ON THE PSYCHOLOGY OF 
SUPERSTITION.* 

By F. B. DRESSLAR, 
Professor of Psychology, University of Alabama. 

It is scarcely necessary to say to this critical and intelligent 
audience that the task imposed by the title of my address is an 
extremely difficult one, and that I cannot hope to say anything 
final on the questions involved. But I trust and believe that all 
thoughtful students of human nature recognize that superstition 
and superstitious belief are still powerful factors in human be- 
havior, and that this field has not been given the attention it 
deserves. I come to you, then, as a student of human nature, not 
to try to impose any set theories, but to discuss with you candidly 
and honestly some of the evidence I have collected relating to 
superstition. 

• In the first place, I wish to call your attention to the fact that 
superstition, so far as we know, seems to be an exclusively human 
manifestation. If the lower animals exhibit in any direct way 
this mental phenomenon, it has thus far escaped scientific recog- 
nition and analysis. True, a few observers have claimed that 
dogs and other of the lower animals have exhibited signs of 
superstitious behavior, but in the strict sense of the word little or 
no incontrovertible evidence has been advanced to sustain their 
contentions. It is safe, at least, to say that if superstitious belief 
is an element in the mental life of the lower animals, it exists 
in a very attenuated form, and has very little influence on their 
general behavior. For all practical purposes it therefore seems 
to be unrepresented, in the true sense, in the mental life of the 

* Annual address delivered at the sixty-sixth annual meeting of the 
American Medico-Psychological Association, Washington, D. C, May 3-6, 
1910. 

IS 



214 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct. 

lower animals. This point of view at once lifts superstition into 
a special realm, and, therefore, while it appears partly to discon- 
nect it from mind as a whole, it predicates it as one of the dis- 
tinguishing marks of human psychic nature. It then becomes 
our task to look at it as a manifestation and a product of higher 
mental life. 

Having made this point clear, I wish now to acquaint you with 
the nature of the evidence I have collected touching this quality 
of the human mind. I have gathered directly from the minds of 
875 different students, whose average age was about 19 years, 
nearly 10,000 specimens of common superstitions. These students 
were engaged in the task of preparing to teach in the public 
schools of this country, and were selected for this purpose by 
reason of general intelligence and worthy moral character. Not 
only were they intelligent in the ordinary meaning of this term, 
but they had passed with credit through the elementary schools, 
and in addition had spent from one to three years in higher 
scientific study. It is fair to say that the evidence of superstition 
I have to present cannot be attributed to personal ignorance or 
to lack of opportunity to come into touch with the methods and 
products of scientific investigation. Of these 10,000 specimens, I 
have tabulated and studied 7176. By reason of the method used 
in obtaining this material, I have been able to classify the speci- 
mens with reference to their frequency of occurrence, to the nature 
of the phenomena interpreted, and to the degree of credence with 
which they were held. In order to make the treatment of the 
material clearer, it will be necessary to explain briefly the method 
used in obtaining it. Imagine, if you will, a group of mature 
students seated in a class-room in the day time expecting to recite 
their lessons or listen to a lecture, but, instead of using the period 
for this purpose, the teacher passed out slips of blank paper and 
unexpectedly asked each student to write out as many super- 
stitions as possible in the hour, and to indicate with scrupulous 
honesty his or her belief or disbelief in each specimen written. 
They were told to mark all those they did not believe in " no 
belief " ; those in which there was a partial belief, " partial be- 
lief " ; and those in which they had unquestioned belief, they were 
directed to mark " full belief." A word further about these state- 
ments of belief seems necessary. These students were directed 



I9IO] F. B. DkESSLAR izIS 

and urged to tell the truth as far as it was possible for them to 
do so, and to leave their specimens unsigned as a means of pre- 
venting any unconscious prevarication. It is perfectly safe, then, 
to assume that there was no prejudice or fear of the teacher oper- 
ating to cause them to overestimate their belief, because it is a 
fundamental trait in human nature to put the best foot foremost, 
and hence the amount of credence they really felt in the super- 
stition each wrote was probably underestimated rather than ex- 
aggerated. No one received any assistance, and no one knew or 
had any opportunity to know what the others had written until 
after the returns were gathered. By this means I was enabled 
to gather the largest list of superstitions ever gotten together, 
and to do it in such a way as to prevent any suggestion or hearsay. 
They were all gathered directly from the minds where they had 
found lodgment, and the belief expressed in them was personal 
belief. 

In order to acquaint you to some degree with the character of 
these returns, and to give you some specific information regarding 
them, permit me to read you some specimens which I have selected 
as types. These will prepare you to estimate the value of the 
discussions which follow : 

No Partial I F11II 

Seller, Belief. Belief. Total. 

" If you pick your teeth with a splinter taken from 

a tree that has been struck with hghtning, you 

will never have the toothache " 001 I 

" If you cut your hair in the new moon it will grow 

better, etc." 7 9 14 30 

" If you see the new moon over your left shoulder 

for the first time, you will have bad luck " 29 24 3 56 

" If you see a star falling, it is a sign some one is 

dying—" 7 7 i 15 

" If a bird flies in at your window, there will be a 

death in the family " 11 11 5 27 

" It is very bad luck to have peacock feathers in the 

house — " 6 I 6 13 

" If a dog howls, it is a sign of death in the 

family—" 17 14 9 40 

" If you break a looking-glass, you will have bad 

luck for seven years — " 48 49 16 113 

" If you drop the dish rag, you will have 

company—" -j-j 39 22 138 

" If you will carry a potato in your pocket, it will 

cure rheumatism" i i i 3 



2l6 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct. 



No Purtlftl Full 

Bell«r. Belief. Belief. ToUl. 



" A potato carried in your pocket will keep away 

rheumatism " 2 . . 2 4 

" If you carry a rabbit's hind foot in your pocket, 

you will never have rheumatism " I . . . . i 

" A horse-chestnut carried in your pocket will cure 

rheumatism " I I . . 2 

" If on retiring at night you insert the toe of one 

shoe in the mouth of the other and then place 

them under your bed, it will cure rheumatism" I . . I 

" If you will put a spider in a nutshell and wear it 

around your neck, it will cure a fever " 5 . . . . 5 

And so on almost to any extent. 

But I cannot take more time to detail to you these specific 
products of superstitious minds. Doubtless each one of you has 
come into contact with many different sorts, and all of you have 
found how persistent and potent they are in the common mind. 
Suffice it to say, I have here a tabulation of 7176 confessions of 
belief or disbelief in more than 3000 varieties of superstitions, and 
that the percentage of belief in them is nearly 45. To be exact, 
of these 7176 confessions made by honest, intelligent, educated 
people, 3225 of them express a belief in them. For example, take 
this specimen which is very commonly known : " If you permit a 
baby less than a year old to look into a mirror, it will die before 
it is a year old." Ten out of eleven people who gave me this 
superstition expressed an abiding belief in the truth of it. Further- 
more, these confessions were so expressed that they left no doubt 
that seeing its own image would be the cause of the death of the 
baby. This attitude represents a phase of human nature, in this 
year of the Lord 1910, and it is a more powerful element of mind 
than most of us have been accustomed to think. But now let us 
turn to the main task suggested by the topic listed on the program. 
What are some of the peculiar characteristics of the supersti- 
tious mind? 

I. Like the critical, scientific mind, the superstitious mind refers 
events or effects to causes. These causes, too, in each case precede 
their effects. So far, then, it is fair to say that superstitious con- 
clusions represent the beginnings of an attempt to explain the 
world of experience by assigning phenomena to definite causes. 
Science attempts to do the same thing. In each case the event 
or phenomenon to be explained must find its value in the mind 



igiO] F. B. DRESSLAR 217 

which has taken it over for consideration. And just here we have 
to make our first fundamental distinction between the behavior 
of a critical, scientific mind and one satisfied with such interpre- 
tations as were detailed to you a few moments ago : 

Superstitious belief is shot through with a fear which grows 
out of a naive acceptance of an animistic conception of the uni- 
verse, in which even sticks and stones understand to a degree the 
behavior of men, and reward or punish them or prophesy for or 
against them. The fear that somehow the universe or some part 
of it is purposely antagonistic or favorable to man begets in the 
imscientific consciousness an almost uncontrollable solicitation to 
a belief despite all reason to the contrary. In the superstitious 
mind, a feeling to believe therefore often takes precedence over a 
belief that is suggested or dictated by reason. The unwillingness 
of many people to sit at table with 13, to live in a house designated 
by this number, or to occupy a state-room so numbered on board 
ship, cannot be accounted for on any other basis than that some 
vague fear compels it. There is no reason in such behavior ; but 
the superstitious feeling is so strong that it would be foolish from 
a business point of view for the builders of a ship to allow this 
number to figure in any part of it. So it happens that in the 
construction of many of our great ocean liners, those wonderful 
products of man's scientific and inventive genius, that this number 
is avoided with painstaking and scrupulous care. This fear of the 
supposed dire influence of the number 13 has persisted at least 
more than 5000 years, for we have definite information that the 
people of ancient Babylon believed in the 13 superstition and rege- 
lated their behavior to some extent accordingly. Five thousand 
years of opportunity to learn that it is unreasonable, and of 
necessity a false conclusion, has not operated to relieve many 
intelligent people of this fear. 

Such a fear, as I have said, is based on a sort of unconscious 
belief that the whole machinery of the universe is in the hands 
of the gods, and that they, for unknown reasons and according 
to their own pleasure, can bring upon man good or bad luck, 
great joy or tribulations. This fear varies in intensity with mental 
and physical conditions. It is likely to be much stronger when 
the body is tired, or sick, or when the mind is ill at ease and 
worried about something. It is usually stronger at night than in 



2l8 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct. 

the daytime, and greatly exaggerated by long-continued separation 
from all social intercourse, such as the sheep-herders experience 
when they follow their flocks into uninhabited regions. Whatever 
intensifies this fear or permits it to hold precedence over the 
reason, or the power to see things as they are, makes for super- 
stitious interpretations. Under any condition, belief is either a 
matter of mere passive acceptance, or a feeling of logical com- 
pulsion brought on by reason of the relations among the facts 
present in consciousness. If fear is there, logic counts for little. 
If fear dictates belief, it is almost hopeless to expect any reason- 
able show of facts to establish its falsity. But whence comes this 
fear and faith, this satisfaction in superstitious conclusions? It 
is, I believe, a psychic predisposition which cannot be understood, 
save as we consider it in its genetic aspect. It is a mental remnant. 
You call the appendix a biological remnant, and often wish it 
were absent from the body, for it is doubtless the source of more 
danger than help to us now. In much the same way we must 
think of this element of superstitious fear in the mind. It is 
probable that it had its origin in conditions long since passed 
away. It is a belated expression of human progress and harks 
back to that stage in development when the conscious life was 
just beginning the quest for a knowledge cf cause and effect. 
Unfortunately, the psychologist or teacher cannot get at it and 
eradicate it as you can the appendix. It is not a function of any 
particular convolution of the brain, it is a product of the emotional 
life and imposes itself on the intelligence in spite of science and 
even critical personal knowledge. This fear, as I have suggested, 
varies in intensity with the changing emotional tones. Sick 
people readily believe in patent medicine advertisements which 
they would neglect or disbelieve when in good health. People in 
trouble readily patronize the most audacious frauds of our modern 
life, the so-called clairvoyants and fortune tellers. Even the 
coming of the night will so change the emotional balance of most 
people that superstitious faith and practice is markedly increased 
during the night. No one ever heard of a daytime ghost. 
Haunted houses are not haunted in the daytime, simply because 
the vague and torturing fear of the nighttime gives place in the 
daytime to a more rational view of things. It often happens, there- 
fore, that just when rational action and judicious behavior is 



1910] F. B. DRESSLAR 219 

more needed, many people give way to the dictates of elemental 
fears and trust to luck, to fortune tellers, or to quack doctors, 
who, by means of the low ethical standards of many of our news- 
papers, are allowed to prey upon the people by arousing their 
fears and appealing to their superstitious weaknesses. (Reads 
advertisements.) 

Medical science has progressed at a truly wonderful rate during 
the past half-century. For the closer application of scientific 
method to the study of the causes and cure of diseases has not 
only given definite guidance in the treatment of certain ailments, 
but has likewise set the medical world to thinking in new direc- 
tions. It may seem strange, to some, in view of these facts, that 
during the same time, and more especially in the last decades of 
this period, superstitious " healing " has become conspicuously 
common. The word superstitious is used in this connection ad- 
visedly. In the light of the most elemental notions of surgery 
and of superstition one cannot on any other basis classify the fol- 
lowing case, which is only a fair and true sample of thousands 
which might be readily collected. " Frank Knowles Butterworth, 
the master printer of Manchester, who refused to call in a doctor 
when his ten-year-old daughter broke her collar-bone, was yes- 
terday sentenced to a month's imprisonment for causing her un- 
necessary sufifering. He is a follower of Dr. Dowie, to whom 
he cabled for prayers for the girl's recovery, and told the court 
he held to the doctrine that all cures are effected by faith and 
prayer." 

Were it not irrelevant to our present purpose it would be sat- 
isfying to commend to the attention of all American justices this 
action of the magistrates of Manchester. 

It was said above that in these modern days superstitious treat- 
ment of disease has become conspicuously common. Perhaps it 
has always been so ; still there seems now to be a growing bold- 
ness about such practices hitherto unnoticeable. There are no 
available statistics to prove this last statement, and therefore it 
must stand as mere opinion ; but it is quite probable that all who 
have read widely and observed closely on this subject will agree 
with it even if it cannot be thus demonstrated. Moreover, if we 
turn to our list of superstitions we find indirect evidence is forth- 
coming that the folk mind is, on the whole, more rational, and 



220 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct 

that no such utter folly as absent treatment for broken bones is 
represented. A statistical study of the superstitions reported 
brings to light the fact that of the ill different kinds having to 
do with the cause, cure and prevention of diseases, more than 
half of these relate to the removal of warts. If we include in one 
class all those relating to very minor difificulties, such as warts, 
sty on the eye and nose-bleed, and combine all others into a 
second class, we find nearly 64 per cent of all the cases reported 
belong to the first class. This suggests that perhaps with the 
folk less reliance is placed on superstitious treatment in cases of 
serious afflictions than in cases of milder and insignificant troubles. 
One could believe that this tendency is equally marked among 
those who practice modern " healing," were it not for the fact 
that the published statement of their doctrine and the criminal 
boldness, which they often show in its application, seem to dis- 
prove it. 

Another somewhat related question which we might put to our 
statistics is this: Do superstitions refer most frequently to pre- 
vention, cause or to cure of diseases? This can be answered by 
saying they refer to all, but chiefly to cures. Out of a total of 
151 specimens returned— and this is an unexpectedly small num- 
ber — 107 refer to cures, 19 to causes and 25 to prevention of 
diseases. Nothing need be said of these figures save to point 
out the fact that they illustrate the general and necessary be- 
havior of the folk mind and conform to the laws of human progress 
as we know them. An ounce of the power to think in terms of 
prevention is harder to develop than a pound of ability to consider 
a situation after it has arisen. 

If we ask the question as to whether the remedies here sug- 
gested have any real efficiency, we can answer only by saying 
if they do, it must come through suggestion. For, with the ex- 
ception of two or three cases, there seems not to be a single speci- 
men in which there is any immediate or sufficient relation of the 
remedy to the disease to effect a cure. If warts can be removed 
by counting them, then it seems certain that the removal is 
brought about through the effect of mind on the body. If a fever 
can be broken up by inclosing a spider in a nutshell and hanging 
it about the neck, the cure must come as the result of faith or 
to natural recover}' rather than as a direct result of the thera- 



igiO] F. B. DRESSLAR 221 

peutic power of the spider. If rheumatic aches can be eradicated 
by carrying a potato, a nutmeg or a horse-chestnut in the pocket, 
ordinary common sense refuses to attribute the cure to any direct 
influence of these objects on the amount of uric acid in the 
blood. If there be any relief, it must be indirect and mental. 

All who study the examples of superstitions referring to dis- 
eases will notice that they are stated as if the real power to cure 
existed in the charm, or the chestnut, the bone, or the black cat's 
tail. This gives them an objective power that, as it seems to me, 
the latter-day " faith curists " are missing. For my part, it 
would be much more conducive to faith in an effectual cure of 
rheumatism if with this result in mind on retiring at night I 
inserted the toe of one shoe into the mouth of the other one, and 
then placed them under the bed, than it would be if, when racked 
by the pain of this distressing disease, I struggled to convince 
myself that after all no such disease existed, and that there is no 
such thing as rheumatic twinges. 

Then there is another advantage growing out of this objective 
method used by the folk that should not be overlooked. They 
can apply it more readily when their domestic animals are ailing. 
For example, if there be any merit in such things, it would cer- 
tainly be much easier to adapt some objective superstitious rem- 
edy to a case of colic than it would be to undertake to persuade 
a groaning horse that he is entirely mistaken concerning his con- 
dition, and that after all there is no such thing as a vigorous 
abdominal ache. Horse sense would likely be too blunt to appre- 
ciate the force of this argument. 

The " faith cure " doctrines rampant in America and elsewhere 
have issued in such multifarious and religious forms in recent 
years that they defy any systematic classification. And they have 
thus reinforced superstition by incorporating some elements of 
it into a religion. That they appeal very largely to a lively and 
potent superstitious impulse is attested by both doctrines and 
devotees. It is not my purpose to deny their feelings or beliefs, 
but simply to assert that they have in no careful and scientific 
way demonstrated the truth of their claims. People who are 
willing to believe in the inspiration of a book which " reads as 
well backwards as forwards," and in either direction appeals 
chiefly to emotional women and credulous men, are ipso facto 
devoid of that just balance in life which subordinates fancy to 



222 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct. 

fact. They rarely feel the need of demonstration, and when they 
do, they are usually incapable of accepting it ungrudgingly, or of 
even knowing when it has been given. But in making this com- 
parison, it would be as unscientific to condemn their doctrines 
and claims as wholly false as it would be to accept them in toto. 
There is plainly an element of truth in " mental healing " which 
must be recognized by all who know anything of the influence 
of mind over body. How far this can go in the cause and cure 
of certain classes of ailments we do not know. It would be an 
easy matter to collect a vast amount of honestly given evidence 
going to establish the most extraordinary cures wrought in this 
way ; but most of this evidence, if not all of it, would break down 
completely or be found insufficient when subjected to rigid scien- 
tific method. This statement is not the expression of mere opinion ; 
it is based on the results of experience and investigation. No 
greater boon could come to the human race than a safe and inex- 
pensive ( ?) way of curing diseases by " absent treatment " ; but 
nothing worse can befall it than a return to the days when desire 
determined belief and fanaticism fastened it. 

Doubtless much greater use is made of superstitious remedies 
among the folk than ordinarily comes to light. One needs only 
to live among them for a short time to realize that belief in all 
sorts of charms for diseases have still a very strong hold on their 
minds. 

Let me close the discussion of the first point with this prac- 
tical suggestion : Whatever will tend to arouse or increase in the 
human mind this elemental fear, this fear of the dark, this animism 
will operate to increase people's belief in superstitious healing, 
in charms, and in cures by absent treatment. If you dignify this 
fear by incorporating it into a religious cult, you will thereby 
strengthen it and fasten it all the more firmly. 

But this animistic faith and belief operates in many other fields 
besides that of health and disease. The belief in luck is a powerful 
factor in modern life. There are thousands of intelligent people 
who would not think of beginning a serious piece of work on a 
Friday, even if all the other conditions seemed most propitious, 
and common reason urged it. They can give no reason for such 
irrational conduct, and when urged to explain the reasons for 
their conduct, they merely say they are afraid to do so for they 
feel as if something would surely happen to prevent its successful 



19 lO] F. B. DRESSLAR 223 

completion. They may even say they do not beheve in luck, but 
they prefer to take no chances. Many engineers and gamblers 
feel safer with a rabbit's foot in their pockets. During a visit to 
Monte Carlo a few years ago, I saw men and women bet on a 
number that had been in some strange way suggested to them, 
and this despite the fact that a moment's calculation would show 
them that they were betting on a certain probability against them. 
The roulette wheel and the table corresponding is plainly marked 
to show this. A good story was told me of how far this neglect 
of fact will go, and how eagerly they seek some occult or divine 
power to help them win. It chanced one Sunday that a gambler 
found his way to the English church in the town, and upon hearing 
the number of the hymn announced, was, as he expressed it, im- 
pressed with the feeling that this was a lucky number to bet on. 
He immediately left the church for the gambling table. He staked 
heavily on this number and won. Following up the suggestion, 
he went to church next Sunday, and after remaining long enough 
to hear the number of the hymn, bet on it again and chanced to 
win the second time. He told the secret of his success to some of 
his friends, and they, too, took to going to church. The contagion 
spread, but the remarkable exodus after the hymn had been an- 
nounced led the rector to suspicion that something was wrong. 
After a little investigation, he located the trouble and took occa- 
sion to announce from his pulpit that no more hymns would be 
sung save those whose number was above 37, the highest number 
on the roulette table. I took occasion to make some inquiry 
concerning the truth of this story, and was told by many honest 
and intelligent people that there was no doubt about the truth 
of it. I saw women repeating rhymes to the images of little pigs 
and then betting on the number suggested thereby, and fully ex- 
pecting this image and the rhyme to exert an influence in their 
favor on the wheel. 

When one stops and candidly inquires into such behavior as 
this, he cannot help seeing that back of it and underneath it there 
is a strong feeling of belief that luck is something tremendously 
real, and that it is possible to get guidance from a rabbit's foot 
or the behavior of a tired fly. It is evident, too, that this guidance 
is expected in the way of some emotional control brought about 
through the power of these things, so that the individual who is 
about to bet will be impelled to select a certain number or combi- 



224 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct. 

nation of chances because he feels strongly that this is to be a 
winner. Psychologically, this is a most interesting situation. It 
is a tacit belief in a universal consciousness in which there exist 
no time distinctions between present and future, and that those 
who will may share in such a mental state. 

When we see a small boy " christening " his taw in order to 
insure good luck at marbles, we laugh over it and pass it by as 
child's play. But when we see those who have grown old enough 
to put away childish things, earnestly and seriously trusting to 
the carved image of a pig to suggest a winning play at roulette, 
our cheeks pale, and our dreams of the divinity and rationality of 
man are rudely disturbed. The added eagerness and concentration 
which christening the taw may bring render the boy's behavior 
highly intellectual as compared with that of the adult who has 
absolutely nothing to do with the outcome of the so-called game 
of roulette. Truly, " man is fearfully and wonderfully made," 
or at least he is at the present time strangely conditioned in the 
process of making. 

The second main point which I wish to emphasize in this analy- 
sis is this : 

Superstitions represent in part those conclusions which men 
have adopted in order to free the mind from the strain of incom- 
pleted thinking. Men are naturally driven to conclusions regard- 
ing the meaning and significance of those phenomena which appear 
in their minds. There can be no physiological or psychological 
equilibrium unless the mind comes to rest in a conclusion. It is 
both physically and mentally very trying to hold in the mind a 
series of conditions and at the same time prevent them from shoot- 
ing together into some sort of denouement. The untrained and 
instinctive mind reaches conclusions quickly, for this temporarily 
is the line of least resistance. Thus it may reach quasi generaliza- 
tions for itself, or, what is more usually the case, it may accept 
the generalizations passed down to it by tradition, for it is easier 
to accept an explanation authoritatively given than to frame one. 

All this is illustrated clearly in the mental development of a 
child. Its reactions come immediately on the presentation of 
mental stimuli and with the least waste of nervous energy. The 
child cannot and will not hold in abeyance for any length of time 
the mental presentations it receives, for to do so would demand 
a mental preparation it does not possess and a power it cannot 



I9IO] F. B. DRESSLAR 225 

exert. It must either rest in its own child-like conclusions, or, 
what is more often the case, it begs for relief by putting almost 
innumerable questions to its elders. Every one will recall the 
definite pleasure a child experiences when his questions are an- 
swered. Almost any answer will do, because it sets the mind at 
rest. At a later stage of development when the analytical powers 
are developing and each phenomenon begins to resolve itself into 
a multiplicity of conditions, the answers are not satisfying unless 
they are more explicit and reasonable. But it will be observed 
that with the folk, as with children, when a definition has once 
been accepted from an authoritative source, it may be retained 
long after the power has developed to see its limitations. This 
is why most of our reconstruction must come through corrective 
thinking and action. When we see that a definition or a general- 
ization will not suffice when put to a practical test, and when we 
can repress our instinctive feelings to believe in it regardless of 
reason, then we are ready for a new one. All this mass of super- 
stitious belief has been handed down from generation to genera- 
tion and clearly shows the desire of the mind to relieve itself by 
means of conclusions already made. No individual can command 
sufficient energy to go it alone, even if he had such a desire. 
Truth is evasive and can only be reached by the masses through 
piecemeal corrections of an earlier faith. 

There is infinite rest in believing in something, even if that 
something will at some future day prove insufficient. There is 
even great relief in the belief that one is traveling the right path, 
though the end be not in sight. A theory considered in this sense 
is an hygienic necessity, for it satisfies the inherent demand for 
temporary conclusions and brings a mental equilibrium essential 
to united personality. The greatest agnostics soon seek rest in 
dogmatism, for they commonly insist beyond the peradventure of 
a doubt that their position is the only one any rational being can 
hold, and they alone have been consistent in argument and obser- 
vation. They try to shield themselves from this criticism, how- 
ever, by accepting the dictum that all truth is dogmatic. The 
fact is, the human organism is so constructed that it must " serve 
God or Mammon." It is impossible for it to function and maintain 
its integrity intact, when the mind rests in no conclusions, and 
therefore wills to do nothing. Disintegration is the only possible 
outcome to consistent agnosticism. It is only the overwrought 



226 SUGGESTIONS ON THE PSYCHOLOGY OF SUPERSTITION [Oct. 

and unhealthy mind that will not or cannot come to conclusions. 
" Sicklied over with the pale cast of thought " is a striking char- 
acterization of one who is afraid to come to a decision, fearful 
lest the conclusion reached will not represent completely and 
exhaustively all of the conditions. Such a mental stage begets a 
nervous tension which rapidly uses up the vital energy, and in 
the end comes to nothing but distress. A complete and healthy 
mental life must develop through piecemeal thinking and cor- 
rective doing. 

The educational implication of this is very important and all 
inclusive. When the generalizations of the adult are given as 
rules to govern the young, there is of necessity a lack of under- 
standing, which can be corrected only by a more or less shortened 
attempt to work it out through experimentation, or (to use a 
better term in this connection) through corrective action. The 
laboratory, the shop, and all other practicable opportunities for 
application, and even life as a whole, are pedagogical necessities 
of prime importance in order to afford those necessary require- 
ments which sound and natural learning demands. 

Belief in superstition is closely associated with narrow ex- 
perience, unscientific observation, the undue persistence of early 
conclusions, and the natuial tendency of the mental life to reduce 
experience to rules or generalizations for guidance in practical life. 

There is some special significance in all this for our people. 
The hurry and rush of modern life, and hence the increased emo- 
tional tensions which must accompany it, operate to throw more 
people back on feeling for guidance than was the case during 
the time when their environment was not so stimulating. Ameri- 
can life puts a premium upon hurried action, and as emotion is 
one of the by-products of these tensions, as well as one of its 
chief instigators, it is easy to see why, those who look on from 
without, call us queer and hysterical. 

And now, if these considerations concerning this elemental pre- 
disposition have seemed a bit harsh or disturbing, or if talking 
in this frank fashion about them has in any way worried you, 
follow this advice, for I have been assured of its efficacy : 

Before retiring to-night, place your shoes side by side upon 
the floor, at the foot of the bed, with the toes pointing away from 
it, and you will sleep soundly and peacefully, and you will not be 
disturbed even by a guilty conscience. 



METHODS OF DEALING WITH THE CRIMINAL IN- 
SANE—DEFECTS IN PRESENT METHODS AND 
SUGGESTED REMEDIES* 

By AUSTIN FLINT, M. D., LL. D., 

Professor Emeritus of Physiology, Cornell University Medical College; 
Consulting Physician to the Manhattan State Hospital, New York. 

The distinctly criminal insane, notably paranoiacs, if at large 
and not under restraint, are admitted to be dangerous to the 
public peace and safety. In the State of New York, this class of 
offenders, when dealt with according to the provisions of the Code 
of Criminal Procedure, is under restraint in the custody of the 
Matteawan State Hospital, an institution devoted exclusively to 
this purpose. The jubilee of the hospital was celebrated in 1909; 
and the report shows that during the 50 years of its existence it 
has received in all 3160 patients. Of this number, 313 had been 
indicted for homicide. In addition, 598 patients had been indicted 
for burglary, a certain number of these, for burglary with assault. 
Thus, more than 50 per cent of the total number committed or 
transferred to Matteawan were more or less dangerous to the 
public peace and safety. 

Of the 313 homicidal insane received at Matteawan, 121 were 
convicts and 192 are classed in the report as " unconvicted." 
Nearly all those classed as " convicts " were women ; which is 
explained by a provision in the statutes, that women are to be re- 
ceived irrespective of length of sentence. No male convicts are 
received except those " undergoing a sentence of one year or less 
or convicted of a misdemeanor." (The Insanity Law, §118.) The 
problem of dealing with these dangerous and irresponsible offend- 
ers is indeed formidable ; but their care is an unavoidable public 
burden, which involves a large expenditure of money. As re- 
gards Matteawan, it is a conservative estimate that the cost of 
site and construction was at least $2,000,000. The cost of main- 
tenance for the year 1908-1909 was $155,000. The State of New 

* Read at the sixty-sixth annual meeting of the American Medico- 
Psychological Association, Washington, D. C, May 3-6, 1910. 



228 DEALING WITH THE CRIMINAL INSANE [Oct. 

York, therefore, pays yearly about $250,000 for protection of the 
people against crimes by the insane. 

The average population of the Matteawan State Hospital for 
1908-1909 was a fraction more than 755. The normal capacity of 
the hospital is 550. The institution, therefore, is now seriously 
overcrowded ; and this condition has existed for several years. 
Overcrowding, unfortunately, exists in nearly all public institu- 
tions ; and it is seldom, indeed, that provisions for public depend- 
ants keep pace with the requirements. 

The congested condition of Matteawan, which is unsafe and 
demoralizing, is in a measure remediable. While a reduction in 
the number of convicts seems impracticable, the class of " un- 
convicted " — from 25 to 50 per cent of the total population — 
includes many who might properly be returned to the courts for 
trial. 

The conditions at Dannemora are quite different from those at 
Matteawan, although both institutions are under the control, as 
regards general administration, of the Superintendent of Prisons. 
The Dannemora State Hospital is " used for the purpose of con- 
fining and caring for such male prisoners as are declared insane 
while confined in a State prison or reformatory, or while serving 
a sentence of more than one year in a penitentiary. (The Insanity 
Law, §140.) The Matteawan State Hospital is "used for the 
purpose of holding in custody and caring for such insane persons 
as may be committed to the said institution by courts of criminal 
jurisdiction, or transferred thereto by the State Commission in 
Lunacy, and for such convicted persons as may be declared insane 
while undergoing sentence of one year or less or for a misde- 
meanor at any of the various penal institutions of the State, and 
for all female convicts becoming insane while undergoing sen- 
tence." (The Insanity Law, §110.) 

The requirements of the Dannemora State Hospital are simple. 
This institution is for the custody and care of insane convicts. 
Such inmates are retained only for so long as they are insane. 
Those who recover are returned to prison to serve out their terms. 
Those remaining in hospital after expiration of sentence are re- 
tained for so long as they are insane or they may be transferred, 
by order of the State Commission in Lunacy, to any of the so- 
called civil hospitals. 



igio] AUSTIN FLINT 229 

The inmates of the Matteawan State Hospital, with few and 
negligible exceptions, may be divided into convicts and uncon- 
victed. Of the 3160 received since 1859, 809 are recorded as 
" unconvicted," a little more than 25 per cent ; 2326 are recorded 
as convicts, and 25 as " cases showing criminal tendencies, trans- 
ferred from other State hospitals, order State Commission in 
Lunacy." Of those admitted during the year ending September 
30, 1909, 45 are classed as " unconvicted," with 46, as under sen- 
tence, about 50 per cent of a total of 91 of the two classes. 

The " unconvicted " are persons committed by the courts, as in 
such a mental condition as to be incapable of understanding the 
proceeding (trial) or making their defense. 

It is provided that this class of inmates, when restored to rea- 
son, shall be returned to the courts for trial. That this should be 
done, and done without undue delay, is just, both to the publio 
and the inmate ; and it is here that a reform in procedure is 
demanded. 

Patients received in a hospital for the insane under ordinary 
commitment are held under an order by a court of record, based 
on an examination and certificate of two qualified examiners in 
lunacy. This certificate gives a fairly complete medical history 
of the case. It is said by superintendents of hospitals for the 
criminal insane that they receive patients from the courts, either 
without histories or with histories so imperfect as to render diag- 
nosis and prognosis difficult. This often leads to undue detention 
of patients, an injustice to the patient and the public alike. 

In my opinion, it should be provided by statute, that when an 
alleged lunatic is committed by the court, a complete medical 
record of the case should accompany the order, the same to be 
incorporated in the case book. In the Insanity Law of the State 
of New York it is provided that, in cases of habeas corpus, .... 
" the medical history of the patient, as it appears in the case book, 
shall be given in evidence, . . . ." (The Insanity Law, §93.) 

It is peculiarly important that full records should be on file at 
hospitals for criminal insane in cases of those indicated as " un- 
convicted." This class includes a few cases of persons acquitted 
on the ground of insanity but committed to an institution as dan- 
gerous to public safety. It seems to me that a new section should 
be incorporated in the Insanity Law, which would provide for a 
16 



230 DEALING WITH THE CRIMINAL INSANE [Oct. 

complete medical record of each and every person sent to the in- 
stitution as incapable, by reason of insanity, of making his defense 
in court, or acquitted on the ground of insanity and dangerous to 
public peace or safety, such record to accompany the order of 
commitment. This new section should also provide for reports to 
the courts, at stated periods, by the superintendent, as to the 
existing mental condition of such patients. Insane convicts are 
transferred to Matteawan from penal institutions (state prisons 
for women, county penitentiaries or workhouses, etc., under the 
provisions of §118 of the Insanity Law). These transfers are 
made under an order by a judge of a court of record on an ex- 
amination and certificate by two legally qualified examiners in 
lunacy. This certificate is a sufficient history of the case ; and the 
Insanity Law already provides for the disposal of such persons, 
either by discharge or by return to prison in the event of recovery. 
The proposed new section to be incorporated in the Insanity Law 
might read as follows : 

§i2ia. When a person indicted for crime, but adjudged to be incapable of 
understanding the proceeding of a trial or making his defense, or when a 
person has been acquitted on the ground of insanity, but it is deemed by 
the court that his immediate discharge zvould be dangerous to public peace 
or safety, is committed to a state hospital, the court shall direct that the 
medical record of such person or persons shall be sent to the said hospital, 
the same lo be incorporated in and become a part of the case book. In such 
cases, the order shall state that such person or persons are committed to 
the said hospital for observation and report; and the superintendent of the 
said hospital shall make reports to the court, within six months dating 
from the time of commitment, as to the mental condition of such person 
or persons, and shall continue to make such reports at intervals not longer 
than six months. 

Within one year after the passage of this act, the superintendent of the 
state hospital for the criminal insane shall report, for each and every 
patient in his custody and care, to the committing court, the mental condi- 
tion of such patients, including diagnosis and prognosis, and especially 
whether the mental diseases from ivhich they are suffering are recoverable 
or not recoverable. 

After the first reports, if there shall have been no material change in the 
mental condition of a patient or patients, a statement of such fact shall be 
deemed a sufficient report. 

Such reports as suggested above, made at stated intervals, 
would certainly contribute to relieve the congestion of state hos- 



I9IO] AUSTIN FLINT 23I 

pitals for the criminal insane, especially in the class of uncon- 
victed. The criminal calenders, at least in the county of New 
York, are always overburdened ; and many under indictment are 
deprived thereby of their right to speedy trial. Under these con- 
ditions, persons under indictment sent to a state hospital as in- 
sane practically disappear and are forgotten. If desirous of trial, 
such persons have a remedy only in writs of habeas corpus. The 
published statistics of Matteawan, unfortunately for my purposes, 
do not show the present number of inmates in the so-called uncon- 
victed class ; but if it be assumed that this is about 33 per cent of 
the total population, there would be 250 inmates whose cases 
should be reported to the courts. It is probable that a considerable 
proportion of these could be certified as not proper subjects for 
further retention in hospital. 

§1120. Penal Lazv. — .'\n act done by a person who is an idiot, imbecile, 
lunatic or insane, is not a crime. A person cannot be tried, sentenced to 
any punishment or punished for a crime when he is in a state of idiocy, 
imbecility, lunacy or insanity so as to be incapable of understanding the 
proceeding or making his defense. 

A person is not excused from criminal liability as an idiot, imbecile, 
lunatic or insane person, except upon proof that, at the time of the 
alleged criminal act, he was laboring under such a defect of reason as 
either, 

1. Not to know the nature and quality of the act he was doing; or 

2. Not to know that the act was wrong. 

It would appear, from this section of the Penal Law, that the 
first question to be inquired into and determined, in the case of a 
person indicted for crime, in which it is alleged that he was, at the 
time of committing the act, laboring under such a defect of reason 
as " not to know the nature and quality of the act he was doing; 
or not to know that the act was wrong," should be whether the 
alleged insanity at the time of committing the criminal act was 
continued and rendered hitn " incapable of understanding the 
proceeding or making his defense " ; in which case he could not, 
under the statute, be tried, sentenced or punished. In cases of 
acquittal on the ground of insanity, it is evident that the rights of 
the defendant would not have been affected by a failure to inquire 
into his mental condition at the time of trial. 

In cases in which a plea of insanity is entered according to the 



232 DEALING WITH THE CRIMINAL INSANE [Oct 

provisions of Section 336 of the Code of Criminal Procedure, it 
seems logical that the court should at once proceed to inquire into 
and determine the existing mental condition of the defendant and 
whether he is capable of understanding the proceeding and mak- 
ing his defense. Statutes already exist which provide for such 
action ; but a slight change, which makes such action, before or 
during the trial, mandatory would often forestall long and expen- 
sive trials, by determining, at the same time, the mental condition 
of the defendant at the time he committed the criminal act. As 
the statute now reads, the matter is within the discretion of the 
trial court. 

§658. Code of Criminal Procedure. — When a defendant pleads insanity, 
as prescribed in §336, the court in which the indictment is pending, instead 
of proceeding with trial of the indictment [must inquire into and determine 
the mental condition of the defendant or] may appoint a commission of not 
more than three disinterested persons to examine him and report to the 
court as to his sanity at the time of commission of the crime 

§454 of the code provides that: 

When the defense is insanity of the defendant the jury must be in- 
structed, if they acquit him on that ground, to state the fact with their 
verdict. The court must, thereupon, if the defendant be in custody, and 
they deem his discharge dangerous to the public peace or safety, order him 
to be committed to the state lunatic asylum, until he becomes sane. 

To return to §658, the second paragraph provides that: 

.... If a defendant in confinement, under indictment, appears to be, 
at any time before or after conviction, insane, the court in which the 
indictment is pending, unless the defendant is under sentence of death, 
may appoint a like commission to examine him and report to the court as 
to his sanity at the time of the examination 

The next section of the code provides for the disposition of the 
defendant if found insane during the progress of the trial : 

§659. If the commission find the defendant insane, the trial of judg- 
ment must be suspended until he becomes sane; and the court, if it deem 
his discharge dangerous to the public peace or safety, must order that he 
be, in the meantime, committed by the sheriff to a state lunatic asylum; 
and that upon his becoming sane, he be re-delivered by the superintendent 
of the asylum to the sheriff. 

An examination of the sections just quoted from the code shows 
that the provisions of §454 and §659 are mandatory ; but in 



igio] AUSTIN FLINT 233 

§658, an investigation, by commission or otherwise, is discre- 
tionary with the court. 

" This section invests the trial court with a discretion to order such 
examination or not as it might, from inspection, observation, and informa- 
tion, judge to be necessary or expedient." People vs. Mcllvaine, 125 N. Y., 
609, 8 N. Y. Cr. 159. 

If it should be made mandatory in §658, by the introduction, as 
suggested, of the words must inquire into and determine the 
mental condition of the defendant or, this would render less fre- 
quent, frivolous pleas of not guilty by reason of insanity ; for a 
plea of not guilty, qualified only by the specification of insanity, 
is an indirect admission of the crime. Indeed, in most cases of 
this kind, the corpus delicti is practically admitted. 

MISUSE OF THE WRIT OF HABEAS CORPUS. 

It is boldness approaching temerity for a layman to venture 
upon a discussion of the sacred writ of habeas corpus. Neverthe- 
less, it is only too evident that the writ is sometimes grossly mis- 
used, especially by the reasoning insane in confinement. A recent 
flagrant example of this is the case of the People against Thaw, 
who is now an inmate at the Matteawan State Hospital as a dan- 
gerous person. The defendant was acquitted, on a second trial, 
of murder in the first degree and was committed to Matteawan on 
February i, 1908. In May, 1908, he obtained a writ of habeas 
corpus returnable before Justice Morschauser. People ex rel. 
Peabody (Thaw) vs. Baker, 59 Misc. 359, May, 1908. After a 
long and costly trial, the writ was dismissed, and the relator was 
remanded to IMatteawan as still insane and dangerous to public 
peace and safety. On a second writ, in July, 1909, returnable 
before Justice Mills, a longer and more costly trial was had, and 
the relator was again remanded as still insane and dangerous and 
probably incurable. People ex rel. Thaw vs. Lamb, 118 N. Y. 
Supp. 389, August, 1909. Various other proceedings, instituted 
with the object of releasing the defendant, have contributed to 
render this case peculiarly scandalous. 

The writ of habeas corpus is for the purpose of detennining 
whether or not the relator is deprived of his liberty " without due 
process of law." In the case of Thaw, this question was settled 



234 DEALING WITH THE CRIMINAL INSANE [Oct. 

definitively in accordance with an overwhelming array of prece- 
dent. The defendant was committed as a dangerous person, as a 
plain duty devolving upon the trial judge under the statute, but 
only until hd should become sane. It was " not a sentence of the 

court The commitment to the asylum is only part of the 

duty cast upon the court " (Clearfield Co. fs. Cameron Township, 
135 Pa. St., at top of p. 93) ; and the commitment was essentially 
temporary. Indeed, public safety requires immediate commit- 
ment of dangerous lunatics without notice. " It is not open to 
contest that such temporary commitments of a summary character 
may be made ex parte and in the exercise of the general police 
power of the State to arrest and temporarily confine dangerous 
persons. They are due process of law." Patterson, J. People ex 
rel. Ordway z's. St. Saviour's Sanitarium, 34 App. Div. 363, 370. 
The consensus of scientific opinion is that paranoia, from which 
the relator (Thaw) is suflfering, is incurable; and the universal 
opinion of alienists is expressed in the general statement that the 
persecuted paranoiac is the most dangerous of the insane. It has 
been held in law " that the presumption of insanity, once found, 
continues ; that the fact that the defendant killed a man is con- 
clusive that he is ' manifestly dangerous,' in the absence of clear 
evidence that his mental condition has undergone a radical 
change." State e.v rel. Thompson t's. Snell, 46 Wash. 327. 

I have cited the Thaw case as a striking example of misuse of 
the writ of habeas corpus, in which it became necessary to have 
two reinvestigations into the mental condition of the relator in 
addition to the question of legality of his confinement. The 
Matteawan State Hospital contains a large number of highly dan- 
gerous paranoiacs, and I am personally familiar with the cases in 
many instances. A large majority of these persons were indicted 
for murder in the first degree. The desire for repeated writs is 
almost universal with these inmates. One always has a writ pend- 
ing; and in another case, counsel has a new writ ready to present 
to the court the moment a pending writ is dismissed. 

A writ of habeas corpus in behalf of a relator who is in custody 
as an insane person and dangerous is quite different from an 
ordinary writ. It involves much more than the question as to 
whether the relator is illegally detained. To quote again from 
the exhaustive and convincing brief of Asst. Dist. Atty. Robert C. 



igiO] AUSTIN FLINT 235 

Taylor, of counsel, in the matter of the People ex rel. A. Russell 
Peabody, Relator and Appellant vs. Robert W. Chanler, Sheriff 
of the County of Dutchess, and Robert B. Lamb, Superintendent 
of the Matteawan State Hospital, Respondents (Thaw case), Re- 
ported 133 App. Div. 159, Affd., 196 N. Y. 525 .... on opin. 
below 

It is obvious that this special habeas corpus provided by §93, Insan. Law, 
provides a remedy far more comprehensive than the ordinary writ of 
habeas corpus. It permits an inquiry de novo into the prisoner's present 
mental state whenever and so often as he claims that he has been restored 
to reason. 

It is not probable that the framers of the Insanity Law contem- 
plated investigation and reinvestigation following reinvestigation 
into the mental condition of patients ; yet practically this is the 
effect of the law in cases in which a command of money affords 
opportunity for endless writs. Without abridging in any degree 
the right of prisoners to inquire into the legality of their restraint 
of liberty, it seems possible to remedy this evil by an amendment 
of the present law : 

§93. Habeas Corpus. — Any one in custody as an insane person is entitled 
to a writ of habeas corpus, upon proper application made by him or some 
friend in his behalf. Upon the return of such writ, the fact of his insanity 
shall be inquired into and determined. The medical history of the 
patient, as it appears in the case book, shall be given in evidence, and the 
superintendent or medical officer in charge of the institution wherein such 
person is held in custody, and any proper person, shall be sworn touching 
the mental condition of such person. 

After one such proceeding, upon which it has been determined that the 
relator is still insane, he shall not be entitled to another such zvrit within 
a period of one year, except for cause shown and in the discretion of the 
judge to whom the application is made. 

It is evident that the State Board of Insanity of Massachusetts 
has recognized the misuse of the writ of habeas corpus by the 
insane, notably the criminal insane. In " the Massachusetts 
Laws relating to Insane Persons, revised and codified, June, 1909," 
is a section on " Commitment of Persons acquitted of Murder, 
etc., by Reason of Insanity," which reads as follows : 

§104. If a person who is indicted for murder or manslaughter is ac- 
quitted by the jury by reason of insanity, the court shall order him to be 
committed to a state hospital for the insane during his natural life, and 



236 DEALING WITH THE CRIMINAL INSANE [Oct. 

he may be discharged therefrom by the governor, with the advice and 
consent of the council, vi^hen he is satisfied after an investigation by the 
state board of insanity that such person may be discharged without danger 
to others. 

Of course this law does not deprive any person of his right to 
an ordinary writ of habeas corpus ; but on the return of sucli writ, 
the issue would be simply to determine as to whether this person 
is illegally restrained. The question of mental condition is, as it 
should be, left to those whom training and experience have quali- 
fied to inquire into and determine such matters. 

At Bridgewater, in the State of Massachusetts, is a State Asy- 
lum for insane criminals ; and it probably is to this institution that 
the section just quoted is intended to apply. The statute has been 
in force since 1873 ; and it does not appear that its constitution- 
ality has yet been called in question. I venture to say, however, 
that if the question of its constitutionality should arise, the fact of 
commitment of a person not convicted of crime, " during his 
natural life," the only remedy being a difficult and complex ex 
parte proceeding such as provided in the statute, could be strongly 
urged against the law. In the " Thaw case," the defendant was 
committed by Justice Dovvling to " be detained in safe custody and 
be sent to the Matteawan State Hospital, there to be kept in said 
hospital until thence discharged by due process of law." The 
" due process of law " referred to undoubtedly is indicated in §454 
of the Code of Criminal Procedure: 

"When the defense is insanity of the defendant the jury must be in- 
structed, if they acquit him on that ground, to state the fact with their 
verdict. The court must, thereupon, if the defendant be in custody, and 
they deem his discharge dangerous to the public peace or safety, order 
him to be committed to the state lunatic asyhim, until he becomes sane." 

The " commitment," in such case, is " essentially temporary " 
and cannot be regarded as a sentence. In the Massachusetts sta- 
tute it is provided that " the court shall order him to be com- 
mitted to a State hospital for the insane during his natural life." 
It might well be argued that this is practically a life-sentence of 
a person acquitted by the jury. 



igiO] AUSTIN FLINT 237 

DISMISSAL OF INDICTMENTS IN CASES OF INMATES OF THE MATTEA- 
WAN STATE HOSPITAL WHO ARE NOT CONVICTS. 

§120 of the Insanity Law reads, in part, as follows : 

.... Any inmate not a convict, held upon an order of a court or judge, 
in a criminal proceeding, may be discharged therefrom, upon the superin- 
tendent's certificate of recovery, made to and approved by such court or 
judge. 

This section does not indicate the procedure in such discharges ; 
but this is provided by the code: 

§661. If the defendant be received into the asylum, he must be detained 
there until he becomes sane. When he becomes sane, the superintendent 
must give a written notice of that fact to a judge of the supreme court 
of the district in which the asylum is situated. The judge must require 
the sheriff without delay to bring the defendant from the asylum, and 
place him in the proper custody until he be brought to trial, judgment, or 
execution as the case may be, or be legally discharged. 

As regards the Matteawan State Hospital these statutes apply 
to inmates classed as " unconvicted," with the exception of those 
who have been acquitted on the ground of insanity and those 
transferred to Matteawan from other state hospitals. It seems to 
me unwise to dismiss indictments in certain of these cases while 
the defendants are still in the hospital, as is not infrequently done. 
■ Many of the " unconvicted " are affected with forms of insanity 
that are recoverable but likely to recur if the patients are re- 
moved from restraint. Typical examples are certain cases of 
alcoholic insanity. About 50 per cent of those committed to 
Matteawan since 1859 were classed as "intemperate" (1494 out 
of 3160). Under hospital restraint and care, most subjects of 
alcoholic insanity recover; but if immediately relieved from re- 
straint on discharge from the hospital, renewed indulgence in 
alcohol is likely to lead to renewed criminal acts. On removal 
from the hospital, such persons should be brought to trial or other- 
wise disposed of according to law. A subject of alcoholic insanity 
with criminal tendencies, so far as his relations to society are con- 
cerned, is little different from an " habitual criminal," who, under 
the statute, may be made subject to legal supervision during his 
natural life " to the same extent that a minor is subject to the 
control of his parent or guardian." It is unfortunate that the 



238 DEALING WITH THE CRIMINAL INSANE [Oct. 

Penal Law does not provide for a similar supervision of persons 
subject to recurrent insanity with criminal tendencies, even after 
acquittal on the ground of insanity ; but it does not appear how 
such a statute could be framed so as not to invade constitutional 
rights. 

The evil of dismissal of indictments of persons in custody as 
unfit to go to trial is emphasized by a recent case of which I have 
some personal knowledge: 

PEOPLE OF THE STATE OF NEW YORK AGAINST JAMES COURTNEY, 
INDICTED FOR MURDER IN THE FIRST DEGREE. 

In November, 1907, I examined the defendant with Dr. William 
Mabon. We testified that he was, at the time of such trial, in 
such mental condition " as to be incapable of understanding the 
proceeding or making his defense." The defendant was then 
committed to Matteawan, where I saw him on several occasions, 
improved, but still insane. He was then, however, fairly coherent 
and connected in his ideas and conversation. He told me that he 
intended to apply for a writ of habeas corpus. I saw him last in 
November, 1909. The rest of the history of this case I take from 
" The Sun " and have no reason to think it inaccurate : 

The District Attorney's office heard nothing of the matter until last 
month, when Mr. Hyde (of counsel for Courtney) informed Assistant 
District Attorney Nott that he had been in correspondence with Dr. R. B. 
Lamb at Matteawan and that Dr. Lamb had written that Courtney's 
condition had not improved. Mr. Nott then wrote to Dr. Lamb, who 
replied that he believed Courtney's condition of insanity was permanent. 

Upon that representation, on March 8 last Mr. Nott went before Judge 
Foster and had the indictment for murder dismissed 

On March 26, 1910, Courtney was committed to the " Tombs," 
on an order from Justice Tompkins, of Nyack, before whom he 
had appeared on a writ of habeas corpus obtained on his personal 
application by mail. 

The prisoner was taken before Judge Tompkins, who conducted the 
examination himself. No attorney appeared for Courtney and no experts 
were heard. Dr. R. F. Kieb of the Matteawan Asylum staff opposed the 
removal of Courtney from the hospital on the ground that he was not a 
safe person to be at large. Judge Tompkins decided that the prisoner 
was in a fit condition to stand trial and ordered that he be turned over to 



I9IO] AUSTIN FLINT 239 

the New York authorities, evidently supposing that the ten-year old 
indictment still stood. No notice of the dismissal of the indictment had 
been received at Matteawan. 

As a result of these complications, Justice Tompkins decided to 
remand Courtney to Matteawan and reopen the case. A rehearing 
was held on April 2 and the case was adjourned for two weeks in 
order to obtain additional testimony. On April 16, Dr. Mabon 
testified that it was not safe for the public for Courtney to be at 
large. The writ was accordingly dismissed, and Courtney was 
sent back to Matteawan. A new indictment had been prepared to 
take the place of the indictment that was dismissed, in case it 
should be needed ; but detectives reported that, of the witnesses to 
the murder, " some had died and none of the others could be 
found." The crime was committed October 7, 1900. 

The case of Courtney is exceptional ; but the conditions existing 
in the State of New York are such, that an indefinite continuance 
of indictments of persons charged with murder in the first degree 
would be unjust to assigned counsel, without some modification of 
the penal law, as will be seen by the following section : 

§308 When services are rendered in pursuance of such assignment 

in a case where the offense charged in the indictment is punishable by 
death, or on an appeal from a judgment of death, the court in which the 
.defendant is tried or the action or indictment is otherwise disposed of, or 
by which the appeal is finally determined, may allow such counsel his 
personal and incidental expenses upon a verified statement thereof being 
filed with the clerk of such court, not exceeding the sum of five hundred 
dollars, which allowance shall be a charge upon the county in which the 
indictment for the action is found, to be paid out of the court fund, upon 
the certificate of the justice presiding at the trial or otherwise disposing 
of the indictment, or upon the certificate of the appellate court, but no such 
allowance shall be made unless an affidavit is filed with the clerk of the 
county by or on behalf of the defendant showing that he is wholly destitute 
of means. 

It has been held, however, that an allowance is not authorized 
where the defendant is found, by a commission, to be insane — 
People ex rcl. Mullen vs. Coler, 61 App. Div. 538. 

In the case of Courtney, the defendant's insanity was found by 
the court on the testimony of the people's experts, and not by a 
commission ; and it is probable that counsel asked for a dismissal 
of the indictment so as to obtain the allowance by the court. 



240 DEALING WITH THE CRIMINAL INSANE [Oct. 

It seems to me proper that an indictment should be dismissed, 
while the defendant is still in Matteawan, on a certificate by the 
superintendent that he is incurably insane and an affidavit by the 
district attorney that he believes the defendant could not be con- 
victed if brought to trial. To provide for this is the object of the 
following proposed new section of the Code of Criminal Pro- 
cedure : 

§66ia. When a person under indictment for a crime has been found to 
be in a state of idiocy, imbecility, lunacy or insanity so as to be incapable 
of understanding the proceeding or making his defense and has been 
committed to a state lunatic asylum until he becomes sane, the indictment 
against him shall not be dismissed white he is in custody in such asylum; 
and the indictment can be dismissed only after such defendant, in case 
he should have become sane, has been redelivered to the sheriff, either on 
a certificate by the superintendent of the asylum that he has become sane 
or under a zvrit of habeas corpus. In case the defendant is under indict- 
ment for an offense punishable by death, the indictment may be dismissed 
upon presentation to a court of competeytt jurisdiction, in the county in 
which the indictment was found, of a verified statement by the superintend- 
ent of the asylum that he is incurably insane and an affidavit by the district 
attorney of the said county that he believes the defendant could not be 
convicted of the crime charged in the indictment or of any degree of murder 
or manslaughter. 



THE ETHICAL ASPECTS OF EXPERT TESTIMONY IN 
RELATION TO THE PLEA OF INSANITY AS A DE- 
FENSE TO AN INDICTMENT FOR CRIME.* 

By CARLOS F. MacDONALD, A. M., U. D., New York. 
Emeritus Professor of Mental Diseases and Medical Jurisprudence, 

University and Bellevue Hospital Medical College; late President 
New York State Commission in Lunacy. 

That existing methods of presenting medical expert testimony 
in the trial of criminal causes is not only imperfect, but is at- 
tended with serious evils which tend to bring the medical profes- 
sion into disrepute with the public, with the bar and with the 
courts, there can be no question. Such being the case, it logically 
follows that there is need of reform in this matter, and the ques- 
tion at once arises, How can that reform best be brought about? 
The method, which as true physicians we would naturally adopt 
in a case of this kind, would be to seek out the cause of the malady 
and then to endeavor to secure the removal of that cause by appro- 
priate treatment. In looking for the causes of the evil complained 
of, we shall not have far to seek. They will readily be found, 
first, in the usage of courts which permits of the selection of ex- 
perts by counsel on either side, without regard to their qualifica- 
tions or standing, usually the only requirement being that the 
expert so selected is willing to give an opinion in favor of that side 
of the case ; and, second, in the absence of any standard of quali- 
fication, fixed by the medical profession, as regards special study 
and experience in a given branch of medical science, which would, 
at least theoretically, render the would-be witness sufficiently 
skilled in that branch or subject to justly constitute him an expert. 

The first-mentioned evil could doubtless be corrected by statu- 
tory provision, not for the appointment of a " Board of Official 
Experts," but for the selection of experts by the court in each 
case; and while it might occasionally happen that a judge in 

* Read at the sixty-sixth annual meeting of the American Medico- 
Psychological Association, Washington, D. C, May 3-6, 1910. 



242 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

selecting an expert or experts would be influenced by other than 
meritorious motives, I think, as a rule, the courts could be relied 
upon to appreciate the responsibility attaching to their action in 
the matter, and to endeavor to select only men of skill and repute 
in that particular branch of medicine — men whose opinions would 
be respected by the bar, the jury and the general public as well. 
Indeed, the very fact that the experts had been thus selected would 
tend to give dignity to their position and weight to their opinions. 
The experts thus selected should be permitted to have free access 
to all the evidence in the case, also to examine the accused, and 
then to state their opinion, whether orally or in writing, subject 
to cross-examination, the cross-examination to be limited to the 
matters embraced in the opinion. Their compensation also should 
be fixed by the court at a rate per diem, or by fee, which should 
be sufficient to induce qualified men to accept such service. Ex- 
perts selected and paid by this method would be free from suspi- 
cion of being biased or influenced in their opinions by pecuniary 
considerations, while the character and the standing of those who 
would be likely to be selected would tend to establish confidence in 
the correctness of their conclusions. 

In a very instructive and able paper on the subject of medical 
expert evidence, Honorable Willard Bartlett, Associate Justice of 
the New York Court of Appeals, says: 

In considering the various projects which have been put forward for 
improving the administration of justice, so far as expert evidence is con- 
cerned, it must be borne in mind that no matter what provision is made 
for the appointment of official experts, the litigants in an action at law 
cannot be prevented from availing themselves of the testimony of other 
expert witnesses. To prevent that, and restrict parties solely to the evi- 
dence of the official experts, constitutional amendments would be necessary, 
involving changes so sweeping as to be antagonistic to the spirit which 
now pervades our judicial institutions. And, if such changes in the 
fundamental law were possible, is it at all certain that they would be 
desirable? I believe that justice in the United States is generally well and 
honestly administered; but such a thing is conceivable as that a judge 
might unwittingly appoint incompetent official experts who were anything 
but representative of the best element in the medical profession. In what 
position, then, might a physician, sued for malpractice, find himself, if 
condemned by their opinions and unable to e.xonerate himself by calling 
as witnesses his non-official brethren whose testimony would demonstrate 
that the appointees of the court were wilfully wrong, or ignorantly mis- 



igiO] CARLOS F. MACDONALD 243 

taken? A man may be a good judge of law, and yet be a very poor 
judge of doctors. I should be sorry to have to be treated by the physicians 
of several able judges whom I have known in past years, and yet, I am 
certain that in each case his physician would have been the first either of 
these judges would select for any official or medico-legal preferment within 
his power to bestow. 

Respecting the second source of the evil, that is, the absence of 
any standard fixed by the medical profession by which the quali- 
fications of a member to give expert testimony may be determined, 
the cure for that Hes in the hands of the profession itself, namely, 
to fix a standard of qualifications based on special study and ex- 
perience in a particular branch of medicine which shall entitle a 
member to rank as an expert in that branch, and at the same time 
putting its seal of disapproval and condemnation on the practice 
which now too frequently obtains of physicians posing as experts 
upon subjects respecting which they have no special knowledge 
or experience, relying upon their wit and the ignorance of counsel 
to save them from exposure. 

The writer fully realizes that the present method of presenting 
expert testimony is by no means perfect, but he believes it is far 
better and more practical than any of the visionary schemes which 
have been brought forward from time to time by medical societies, 
by bar associations, and even by certain alienists. Such, for in- 
stance, as the appointment of a " Board of Official Experts " by 
the courts, or by medical societies, or by the governor of the State, 
etc. In the writer's opinion it would be difficult, if not impossible, 
to devise any method that will supplant the present one short of 
a change in our federal constitution. This opinion is sustained 
by many if not most of the judges who hold that a defendant on 
trial has a constitutional right to present any proper evidence 
that might aid him in his defense. 

It would doubtless simplify matters, were it feasible to do so, 
to provide that questions of expert opinion should be passed upon 
by the court, instead of, as is now the case, by a jury of laymen, 
who are not supposed to be familiar with the intricacies of psycho- 
logical medicine. The spectacle of a jury of laymen being called 
on to decide as to which of the opinions of opposing expert wit- 
nesses respecting an obscure and difficult question of disease is 
correct is a rcductio ad absnrdum which has been too often pointed 



244 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

out to call for more than a passing mention here. This practice, 
unfortunately, is one that cannot be abolished, for the reason that 
the terms of our federal constitution confer upon every citizen 
when charged with crime the sovereign right of trial by a jury 
of his peers. 

Respecting the propositions to provide for the appointment of 
a " Board of Official Experts," whether by the governor of the 
State, by the courts, or by a State commission in lunacy, it is the 
writer's opinion that none of these methods would be desirable 
or acceptable, either to the medical or legal professions, or to the 
public, for the reason that it would savor of class legislation, which 
is against sound public policy. Furthermore, the prospective ad- 
vantages through professional prominence and pecuniary gain, 
whether in fees or in salary, which such appointment would offer, 
would lead incompetent and unworthy members of the profession 
to seek appointment thereon through partisan or other questionable 
influences. Moreover, such a board, even if fairly representative 
in its make-up, would be a ready target for unfriendly or hostile 
criticism by their less fortunate brethren in the same line of 
practice who might, whether justly or unjustly, regard themselves 
as being discriminated against. Then, too, it would require either 
a very large board or several boards to provide a sufificient number 
of experts in the various branches of medicine, surgery and chem- 
istry in which medico-legal questions arise. Says Mr. Justice 
Bartlett in the paper referred to: 

There is not likely to be any radical change in a matter of legal pro- 
cedure like this, without the approval of the bar, and I doubt very much 
whether the bar would approve any legislation which would enable the 
courts or any other appointing power to create a privileged class of expert 
witnesses. 

For the reasons herein set forth, it would seem to the writer 
that the most practical solution of the difficulty would be to make 
statutory provision for the appointment by the court of, say, from 
one to three experts whenever occasion arises, the law to provide 
that only physicians of repute in the particular branch of medical 
science to which the question for expert opinion relates shall be 
appointed, these experts to have full and free access to all the 
evidence in the case, as well as to the defendant, for the purpose 
of examination, and then to submit to the court for transmission 



igiO] CARLOS F. MACDONALD 245 

to the jury a written report, setting forth their conclusion and the 
facts in evidence on which such conclusion is based, the cross- 
examination of the experts to be restricted to matters embraced 
within their direct statement of facts and opinion, and the com- 
pensation of the experts to be fixed by the court. The writer is 
well aware that lawyers would raise objection to this manner of 
selecting experts, on the ground that a defendant is constitutionally 
entitled to the selection of his own witnesses, and to call any 
witnesses whose testimony would tend to sustain his case — a right 
which can neither be taken from him nor abridged. This objec- 
tion, however, would be met by the fact that counsel would still 
be permitted to call experts in addition to those selected by the 
court ; though it is safe to say the opinion of the official or court 
experts would far out-weigh any differing opinion that might be 
offered by experts selected by counsel. It goes almost without 
saying, too, that this method of selecting experts would always 
be satisfactory to the prosecuting attorneys. 

There is another point in connection with this subject which, 
in the writer's opinion, should receive not only the attention of 
this Association but of the general medical profession as well, for 
the reason that it is frequently a source of discredit to our profes- 
sion. This refers to the unprofessional practice of certain medical 
men — mostly pseudo-experts — acting as medical advisor to counsel 
and as expert witness in the same case. To observe, as the writer 
has often done, medical men sitting in court at the elbow of 
counsel, actively engaged in taking notes and preparing or sug- 
gesting questions for the latter to put to the witness, also framing 
questions for the cross-examination of a fellow practitioner and 
otherwise openly assisting counsel in his efforts to break down the 
opposing side, and subsequently taking the witness stand for that 
purpose, is, to say the least, deplorable. If a physician is to appear 
as an expert witness, he should keep away from counsel while in 
court and take no part in the conduct of the case which would 
put him in the attitude of assistant counsel or of a biased or 
interested party. In the first trial of Thaw the writer was selected 
by the district attorney to assist him in the preparation of the 
medical branch of the trial, a service which he accepted with the 
distinct understanding that he would not appear as a witness in 
the case. 
17 



246 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

Anent this subject Mr. Justice Bartlett, in the paper referred 
to, says: 

In my opinion the law can do very little toward making experts or any- 
body else honest or upright or capable in their particular pursuits. I look 
for reform rather in the direction of the development of a higher sensibility 
on the subject in the medical profession itself. It is entirely possible for 
the doctors of this state or country to so frown upon the practice of acting 
as medical counsel and medical witness in the same case as to stamp it out 
completely. There is nothing to prevent a physician who is asked to see a 
case with reference to giving testimony as an expert from exacting an 
agreement that his remuneration shall in no wise depend upon the opinion 
which he may form upon making the desired examination ; or, in other 
words, that he shall be paid just the same and just as much whether his 
conclusion is agreeable or disagreeable to the attorney who seeks his 
services. No attorney will refuse to consent to this course unless he is 
desirous of influencing the doctor to take one view of the case rather than 
another, because in that event he will get paid while otherwise he may get 
nothing. A tempter of this sort should be shut out of the doctor's office 
with no gentle slam of the door. And so in many other ways which might 
be suggested some of the most serious evils of medical expert evidence 
may be effectively dealt with by " reform within the party." 

Respecting the sweeping condemnation of medical expert testi- 
mony in which the courts, the public press, and to some extent 
the medical press, are wont to indulge, Mr. Justice Bartlett, re- 
ferring to the common assumption by lawyers and doctors that 
courts and juries would be sure to get at the truth if the expert 
witnesses on one side could only be induced to agree with the 
expert witnesses on the other, cites a case in point which occurred 
in California, in which the plaintiff, a married woman, was injured 
in an accident upon the defendant's railroad. In the suit which 
she brought against the railroad company to recover damages, one 
of the principal questions was the extent of the injuries which she 
had sustained. She had been examined by three or four medical 
men in her own behalf and by three or four other medical men in 
behalf of the defendant. Both those who testified for the plaintiff 
and those who testified for the defendant agreed that the plaintiff 
was suffering from a uterine or ovarian tumor, but there was 
a difference of opinion as to whether the tumor could have been 
produced by the plaintiff's fall. A verdict of $20,000 was rendered 
against the railroad company. Ten days after the trial the plain- 
tiff gave birth to a child at full term, although still-born, and it 



I9IO] CARLOS F. MACDONALD 247 

was admitted that there had been no tumor whatever ! " Since 
the time of Mr. Pope," says the Supreme Court of Cahfornia, " it 
has often been inquired ' who shall decide when doctors dis- 
agree ? ' " This case shows that serious error may lurk in their 
conclusions, even when they have agreed. Such an occurrence, 
if narrated in a work of fiction, would be criticised as so improb- 
able as to be ridiculous ; but there is no romancing in the cold 
type of a volume of modern law reports. The possibility of so 
serious an error being committed by so many respectable members 
of the medical profession — for the court speaks favorably of their 
standing — tends to afford some justification for the popular dis- 
trust with which medical expert evidence is often regarded. Con- 
tinuing, the learned justice says: 

In reference to this matter, however, I desire to express my dissent from 
the sweeping condemnation of medical experts in which the courts so often 
indulge. There is scarcely a case where expert evidence is taken, in which 
some of the experts are not perfectly honest. They do not deserve de- 
nunciation merely because other experts are dishonest, or because it is 
often difficult to tell the false from the true. The medical profession itself 
must help us to make the distinction between the two classes easier. 
However objectionable are some of the aspects of medical expert evidence, 
it cannot be dispensed with in the administration of justice. Let us remedy 
the evils, but, while we are endeavoring to do so, let us avoid that exagger- 
.ated denunciation which is calculated to convince the community that no 
surgeon or physician who takes the witness-stand as an expert is worthy 
of belief. Such teaching is a libel on the most unselfish profession in the 
world. 

What I have said thus far has been so largely in the nature of destruc- 
tive criticism, that I may naturally be asked whether I have no remedy 
to suggest for the manifold evils in regard to medical expert evidence 
which are generally recognized in both professions. In concluding this 
paper, let me add a few observations in answer to this question. I should 
be sorry to feel that the prospect of reform was hopeless. There is one 
direction in which it seems to me brighter than any other. You have a 
code of medical ethics which every physician and surgeon is bound in all 
professional honor to observe. By that code you regulate your own con- 
duct in the practice of medicine, and insist that those who join the ranks 
of your profession from year to year shall agree to regulate theirs. No 
statute could practically be more binding. Why may you not e-xtend its 
provisions so as to embrace the conduct of the medical man when he 
assumes the role of the expert witness? The matter is absolutely within 
your own control. You can declare in your code that a certain course of 
action on the part of a medical expert shall be deemed honorable and 



248 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

professional, and that a certain other course of action shall be dishonorable 
and unprofessional. The first steps in enacting such amendments in your 
professional law would necessarily be tentative. Mistakes would be made 
which you would have to correct. Rules from which the most good was 
expected might prove useless, and others which promised much less might 
prove to be the most effective of all. But in making them and changing 
them you would be independent of the legislature ; you could act solely 
for the good of your profession, untramelled by official influence or power; 
and so far as you desire advice from the bench or bar, I am sure it would 
be gladly aflforded. A signal advantage of dealing v/ith the subject in 
this way is that it would involve no interference with existing rules of 
judicial procedure. The rights of litigants or the manner of trying law- 
suits would in no wise be affected. The needed reforms would be brought 
about by the compulsory operation of your own code of ethics acting per- 
sonally upon each member of your profession. That code, amended as I 
am sure it might be if the physicians and surgeons of this country took the 
matter seriously in hand, by commanding medical experts to do what is 
right and subjecting them to professional censure and obloquy if they did 
what was wrong, would be more efficacious than any law on the subject 
which any legislature could enact. It would be your own law, adopted 
by yourselves for yourselves, and it would have that powerful sanction 
which belongs alone to laws which are a natural growth out of the con- 
ditions which lead to their adoption. To the action of your profession in 
some such way as this, I look with more confidence than anywhere else 
for the ultimate accomplishment of all that is desirable in the improve- 
ment of medical expert evidence. 

In connection with this branch of the subject the writer would 
take occasion to suggest that it is the duty of the medical profes- 
sion to raise its voice in solemn protest against the tendency which 
has lately grown up to heap upon it ridicule and abuse because 
" doctors disagree," and that consequently all, or substantially all, 
doctors are dishonest. As a matter of fact, doctors are no more 
prone to disagree than any other class of individuals where mat- 
ters of opinion are involved. On the other hand, lawyers are 
notorious for their disagreements. In fact, in every case that is 
tried in court we find the contention of counsel on one side is 
diametrically opposed to that of the other side ; and this, too, on 
substantially the same state of facts. Then, too, judges are also 
notorious for their disagreements. The higher courts frequently 
reverse the court below, clear up to the court of last resort; and 
it is safe to say if there were still a higher court it would be found 
overruling the court of appeals. How frequently, too, we find 



IQIO] CARLOS F. MACDONALD 249 

the body of judges constituting the appellate courts divided in 
the decisions they render, the issue being decided oftentimes by 
a bare majority of one. And yet nobody would think of sug- 
gesting that these judges are dishonest simply because they happen 
to disagree. 

Mr. William A. Purrington, an eminent member of the New 
York bar, and one of large experience in medico-legal matters, 
in a recent paper referring to the disagreements of judges whom 
he characterizes as 

that great body of experts who rarely if ever go upon the witness-stand, 
yet are always under a continuing oath, and in every case from the facts 
before them render their opinions as to the law. When they give an 
opinion, whether it be right or wrong in our opinion, it is of binding force 
until set aside ; and that is more than can be said of yours of the faculty, 
or ours of the bar. I have sometimes wondered whether those judges 
who have been most denunciatory of the differing conclusions at which 
reputable medical experts have arrived upon the facts in evidence, have 
reflected that they, too, belong to a body of experts in the law, whose 
members often differ, very honestly and ably, in drawing conclusions, even 
from agreed facts. 

Mr. Purrington then goes on to cite in illustration of his point : 

The recent medical case of the People vs. Hawker (14 App. Div., 188; 
152 N. Y., 234; 170 U. S., 189) wherein the facts were agreed upon, and 
the only question involved was one of law, whether a statute forbidding one 
convicted of felony to practice medicine could apply to a hcensed physician 
so convicted prior to its enactment ; in other words, whether the statute 
was ex post facto. The trial judge decided negatively. The appellate 
division of this department, by a vote of three to two, reversed him ; 
the court of appeals in turn reversed the appellate division, two of its 
judges dissenting; and finally, the Supreme Court of the United States, 
after two arguments, affirmed the court of appeals, three of its members 
dissenting. Surely no one would presume, because of these differences of 
opinion to doubt for a moment the ability, the learning and the absolute 
honesty of these various experts of the law; and it is equally manifest 
that the frequent differences of opinion among medical experts — the only 
class we are now considering — should not of themselves alone justify the 
criticism so freely made. 

District Attorney Jerome, in a recent public utterance, declared : 

No man has had more experience with experts than myself during the 
eight years I was district attorney and during that time I recall only one 
man whose testimony was radically dishonest. Only one of these cases 
received great public attention, and that was on account of the scandals 



250 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

connected therewith. These scandals were not, however, save with one 
exception, due to dishonest expert evidence, but to judicial incompetency. 
It does not follow because there are alienists who lie on the witness stand 
that all medical expert evidence should be abolished, any more than that 
because some lawyers coach witnesses to a point that amounts to suborna- 
tion or perjury, the conduct of criminal cases should be left entirely to 
the judge. I have referred to the Thaw case and you all know whom I 
mean when I say that there was one man who testified on that occasion, 
who, in view of his testimony in that case, and in view of his evidence 
since and his own written report, would be expelled from the profession, 
if you gentlemen had the power to disbar him. I may say that in every 
case during my term of office the opinion of the experts retained by the 
State was justified by the subsequent clinical history. 

The Hypothetical Question. — Respecting the hypothetical ques- 
tion it must be conceded that it is a very difficult proposition with 
which to deal, especially so far as relates to any improvement or 
proposed modification of existing rules of practice relative thereto. 
The rules of evidence provide for the hypothetical question, and 
the courts have held that while such question must contain nothing 
that is not contained in the evidence they do not prohibit the 
omission of any facts in evidence which counsel may in their 
discretion see fit to omit. Hence, it frequently occurs that 
counsel sifts and omits from his hypothetical question certain 
important facts in evidence which, if incorporated therein, would 
tend to weaken or discredit his contention, and he is prone to 
include in his question only such facts in evidence as he thinks 
will tend to prove his case. Consequently, the hypothetical ques- 
tion usually is a one-sided affair. The writer has frequently sug- 
gested, and sometimes insisted, that the question to be submitted 
to him should embrace a fair resume of the whole evidence, and 
when this plan has been followed he has usually found that he 
could answer the question thus constituted as consistently and to 
the same effect as he could have answered what might be termed 
an ex parte question. This, it seemed to the writer, has tended 
to strengthen his testimony in the estimation of the court and 
of the jury, and at the same time relieve him from appearing to 
be an unfair, one-sided and partial witness. 

The Legal vs. the Scientific Definition of Insanity. — The legal 
definition of insanity as a test of responsibility for criminal acts, 
that is, the so-called " knowledge of right and wrong test," pre- 



I9IO] CARLOS F. MACDONALD 25 1 

sents a feature of the administration of the criminal law in which 
the legal profession has made little or no progress for more than 
half a century, or since the legal definition of insanity was formu- 
lated by the English judges in their decision in the celebrated 
McNaughten case in 1843. In fact the criminal code of the State 
of New York to-day defines insanity in substantially the same 
language as that used by the judges in the McNaughten case, 
namely : 

A person is not excused from criminal liability as an idiot, imbecile, 
lunatic or insane person, except upon the proof that, as the time of com- 
mitting the alleged criminal act, he was laboring under such a defect of 
reason, as either (i) not to know the nature and quality of the act he 
was doing; or (2) not to know that the act was wrong. 

As alienists we can hardly accept this " right and wrong " 
test as regards responsibility for crime. But as this is the law 
of the State of New York, and of many other States in the Union, 
we are obliged to abide by it. In fact, as experts, we have 
nothing to do with the law. Our function is simply to determine, 
if possible, the mental condition of the accused at the time the 
act was committed — a purely scientific question. Now, every 
alienist knows perfectly well that this so-called legal definition is 
unscientific and way behind the age, and that in this matter the 
law has not kept pace with the progress of medical science. Those 
who are familiar with the phenomena of mental disease know 
perfectly well that in a large majority of cases in which the plea 
of insanity is oflfered as a defense to an indictment for crime, 
the accused knows the difiference between right and wrong in the 
abstract — a large majority of the so-called " dangerous " or " crim- 
inal insane " being paranoiacs. We know that paranoiacs as a 
rule converse coherently and plausibly, and that they reason log- 
ically respecting their delusional ideas, but that they always reason 
from wrong premises, the mental condition being one of gradually 
developed delusional ideas of the systematised variety, without 
marked mental deterioration or clouding of consciousness. So 
that, in most cases, with us the question is, not whether the indi- 
vidual knew the nature and quality of the act he was doing, and 
knew that it was wrong, but whether he had the power to control 
his act and to resist the impulse to do the wrong, or whether 



252 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

he was actuated by delusion which supplied the motive, impelling 
him to do the act. 

Now, if every form and stage of mental disease were invariably 
attended by a loss or suspension of the knowledge of right and 
wrong, such as usually occurs in extreme types of mania, melan- 
cholia, paretic-dementia, etc., forms or stages of the disease which 
are usually characterized by mental aberration so marked as to 
bring them easily within the ken of unskilled observers who would 
readily recognize the symptoms which in themselves furnish pre- 
sumptive evidence of a lack of power to distinguish rationally 
between right and wrong, no valid objection could be raised to 
the present legal test of insanity, wrong in principle though it be, 
for the reason that its practical eflfect, as applied to the class of 
cases referred to, would be to establish irresponsibility in sub- 
stantially every case, regardless of the nature of the act com- 
mitted. Unfortunately, however, but a small percentage of the 
insane who come within the jurisdiction of our criminal courts 
belong to the types of insanity referred to, this class of persons, 
being usually not homicidal, seldom commit, or attempt to com- 
mit, homicide, or what is technically known as crime against the 
person. In other words, such persons do not belong to the " dan- 
gerous insane," consequently there is little or no difficulty in such 
cases in determining the question of responsibility, for the reason 
that they readily fall within the legal conception and definition of 
mental disease. It is the obscure and doubtful cases that so 
frequently puzzle our courts of criminal jurisdiction, and these 
are drawn almost wholly from the ranks of the paranoiacs ; and 
this class, as we all know, frequently commit crimes from mo- 
tives similar in character to those which actuate sane persons, 
namely, revenge, vindication of personal honor, defense of life 
or property, etc. But if we seek the basis of these motives we 
shall find that, unlike the the motives of the sane, they are not 
founded on reality, but are the offspring of a diseased or dis- 
ordered intellect, a psychopathic state which has deranged the 
psychical apparatus, so to speak, and left it awry, even though 
the logical apparatus remains intact. The paranoiac is prone to 
premise falsely and to morbidly misinterpret the conduct and 
motives of those about him. And while he may reason logically, 



IpIO] CARLOS F. MACDONALD 253 

he reasons from wrong premises and in a way that a sane man 
would not do. Such being- the case, it frequently happens that, 
under the requirements of our criminal code, we are put in the 
false position of testifying in effect that a defendant was legally 
sane when he committed the act, that is, that he knew the nature 
and quality of the act and knew that it was wrong, when as a 
matter of fact we know that he was insane and irresponsible, 
according to the teachings of medical science. 

It has been suggested that the most satisfactory way to deal 
with criminal cases, especially capital ones, in which insanity is 
pleaded as a defense, would be to keep the question of insanity 
out of the case entirely during the trial, and to allow the jury 
to pass only on the question of the guilt or innocence of the 
accused, irrespective of his mental condition ; then, if the defend- 
ant is convicted, let the court appoint a commission of competent 
alienists to determine his mental condition. Such a commis- 
sion could be relied upon to reach a sound and harmonious con- 
clusion. The writer does not pretend to say that this method 
would be feasible, but it would at least seem to offer an improve- 
ment on the present method of determining the mental condition 
of a defendant which puts upon a jury of laymen, who presumably 
are not familiar with the phenomena of mental disease, a respon- 
sibility which they should not be called upon to assume. If the 
function of the jury were restricted to a finding on the facts, that 
is, if the defendant committed the act as charged, and, subse- 
quently, the question of his mental condition were determined, by 
competent alienists appointed by the court, it is believed that the 
finding of such a commission would be accepted by the public, 
both lay and medical, and that there would be no danger of a 
miscarriage of justice. If this method were feasible under the 
constitution it would seem to furnish the best solution of expert 
testimony in criminal cases in which the mental condition of the 
accused is in issue. 

" So long as mind and intention shall be held to constitute the 
foundation of legal responsibility," says Ordronaux,' " so long 
will their absence be likewise held to exonerate from all imputa- 

' Judicial Problems Relating to the Disposal of Insane Criminals, by 
John Ordronaux, M. D., 1881. 



254 EXPERT TESTIMONY IN INSANITY TRIALS [Oct. 

bilily of crime." In other words, before there can be guilt, there 
must be mental competency to concoct it. And yet, despite this 
truism, there still exists in both lay and medical circles a wide 
diversity of opinion as to how far insanity should be held to 
absolve from criminal responsibility. These diverse and even 
opposite views have existed from the time that Lord Hale under- 
took to define the exact extent to which the mental movements 
were influenced by insanity, and its consequent effect in impairing 
the responsibility of its victims, down to the present time. As a 
result of his investigations, Lord Hale concluded that while the 
milder forms of insanity might not be sufficient to excuse one 
from responsibility for criminal acts, a sufferer from the severer 
types of the disease would be excusable for any crime he might 
commit under its influence. Subsequently, in 1843, the English 
judges, in response to questions put to them by the House of 
Lords, in connection with the celebrated McNaughten case, formu- 
lated a definition or test of insanity which was substantially the 
same as the one put forth by Lord Hale. In the language of the 
learned English judges: 

To establish a defense on the ground of insanity, it must be clearly 
proved that at the time of committing the act, the accused was laboring 
under such a defect of reason, from disease of the mind, as not to know 
the nature and quality of the act he was doing, or, if he did know it, that 
he did not know he was doing what was wrong. 

From the time this judge-made law was promulgated down to 
the present day our criminal courts with their traditional regard 
for precedent have generally accepted it blindly and propounded 
it to juries in almost identical language, notwithstanding the 
emphatic protest of medical men that such test is in direct con- 
flict with the teachings of medical science and false in its applica- 
tion to the mentally unsound. As before stated, the Revised 
Code of Criminal Procedure of the State of New York, Section 
21, defines insanity in practically the same terms as those used by 
the English judges in the McNaughten case. Thus it appears 
that our lawmakers blindly following the dictum of Lord Hale 
and his successors on the English bench, and ignoring the teach- 
ings of medical science, have undertaken to determine by statu- 
tory enactment what insanity is and to define the conditions of 



igiO] CARLOS F. MACDONALD 255 

responsibility in mental disease by declaring in law what shall be 
rather than what is, and have thus given us a test which is based 
on a misconception of the true nature of insanity, and so narrow 
in spirit and so untenable in reason that every experienced alienist 
must regard it as artificial, arbitrary and fraught with danger to 
humanity and to the ends of justice. " The true test of irre- 
sponsibility " says Forbes Winslow, " should be, not whether the 
party accused is aware of the criminality of his actions, but 
whether he has lost all power of control over his actions." 
" Make the man's power of controlling his actions the test," says 
Clouston. " With that view every medical man will agree." 

Hence, it would appear, if medical science is correct, that the 
real question of fact for the jury to determine in criminal trials 
where insanity is alleged, is: Did the accused at the time he 
committed the act of which he is charged have sufficient mental 
capacity to appreciate rationally the nature and consequences 
of the act he was committing, and, if so, had he sufficient power 
of will to enable him to choose between doing it and not doing it ? 
It must be admitted that a correct solution of this question, in- 
volving, as it does, human life and liberty, is of vital importance ; 
and inasmuch as it relates directly to disease, the facts upon 
which its solution depends, can properly be interpreted for the 
jury only by competent medical testimony. If this were done it 
is believed that much of the conflict of opinion in our law courts 
respecting the question of responsibility in criminal cases where 
insanity is offered as a defense would disappear. 



THE INTERMITTENT FORMS OF DEMENTIA 
PRECOX.* 

By WILLIAM RUSH DUNTON, JR., M. D., 
Assistant Physician, Shcppard and Enoch Pratt Hospital, Towson, Md. 

In a previous paper/ attention was drawn to three rather unique 
cases, two of which had for a long time been considered as be- 
longing in the manic-depressive group, but in recent years had 
shown symptoms which were more characteristic of dementia 
prgecox, and another which had early been diagnosed as paranoid 
dementia prsecox, but which soon after the onset of acute symp- 
toms showed a cyclic course. It was proposed that to these three 
cases should be applied the term cyclic dementia prsecox as being 
most descriptive. Mention was also made of the intermittent 
forms of dementia prascox and the present paper is an attempt to 
point out some of the characteristics of this form and to contrast 
it with the cyclic form. It may first be well to review the char- 
acteristics of the cyclic form : Briefly stated it may be said that 
cyclic dementia prsecox is a form of insanity closely resembling 
folie circnlaire in that there are frequently recurring abnormal 
periods of excitement and stupor, these abnormal periods being 
succeeded by normal periods, usually of briefer duration. While 
at first the excitement may seem to resemble that of manic- 
depressive insanity, closer study will show that there is no true 
flight of ideas, there is usually evidence of stereotypy. Muscular 
rigidity, flexibilitas cerea, or hypertonus is also present and motor 
restlessness may be slight. The stupor does not resemble that of 
manic-depressive insanity and is also characterized by muscular 
rigidity. In the normal periods the patient may for a long time 
give little evidence of dementia and merely show the narrow men- 

* Read at the sixty-sixth annual meeting of the American Medico- 
Psychological Association, Washington, D. C, May 3-6, 1910. 

' The CycHc Forms of Dementia Pr;ecox, American Journal of Insanity, 
Vol. LXVI, p. 465. 



2S8 THE INTERMITTENT FORMS OF DEMENTIA PR^^ICOX [Oct. 

tal horizon of a person who is cut off from active life, but after 
several years dementia may be apparent. As a rule an emotional 
dulling being shown before an intellectual one. 

It will be seen by a study of the series of cases here presented 
that the diagnostic difficulties may be great. A number of these 
cases were considered as belonging to the maniacal-depressive 
group until later observation had made such a diagnosis untenable. 

It is recognized, of course, that no classification of cases can 
entail precise limits and that there will always be a number which 
it will be difficult to place and even when this has been done we 
may feel doubtful as to the correctness of such grouping. It will, 
however, add to a better understanding of this paper if a few pre- 
liminary remarks be made upon the principles which have guided 
me in my conception of dementia prsco.x and of maniacal-depres- 
sive insanity. 

In the first place, as does Kraepelin, I " provisionally " group 
those cases who dement, excluding, of course, the organic de- 
mentias, into one great group which I consider as dementia 
prnecox, recognizing, however, besides dementia or deterioration 
that certain other symptoms must be present at some time in the 
course of the disease, these constituting what I call the dementia 
prjecox syndrome as contrasted with the maniacal and the de- 
pressive syndromes. 

As is well known the maniacal syndrome is : 

1. Elation. 

2. Flight of ideas. 

3. Psychomotor excitability. 
And the depressive : 

1. Emotional depression. 

2. Difficulty in thinking. 

3. Psychomotor retardation. 

Evidently these are based on the old division of the mental 
faculties into emotion, will and intellect and as a convenience in 
teaching I have formulated the following syndrome as character- 
istic of dementia praecox : 

1. Apathy. 

2. Dissociation. 

3. Eccentricities. 



IQIO] WILLIAM RUSH DUNTON, JR. 259 

On the other hand, cases which belong to the maniacal-de- 
pressive group, besides showing either the maniacal or depressive 
syndrome, do not dement. 

With these broad generalizations as starting points, and the 
presence of other symptoms, it is possible to make the differentia- 
tions into the various sub-groups of these two great divisions. 
As this paper deals with but one of these sub-groups, it does not 
seem proper to discuss at length the others, and I shall, therefore, 
proceed at once to a discussion of the intermittent forms. 

So far as I know there has been little written especially con- 
cerning the intermittent form, Kraepelin in the seventh edition of 
his Psychiatrie making no reference to it. 

In the first place, one may say that the intermittent form of 
dementia praecox is that which is characterized by a series of at- 
tacks whose chief characteristic may be excitement or depression, 
but in which symptoms of deterioration gradually become appar- 
ent. Between these the patient may appear to have become or 
reached his normal, but in each succeeding attack he may show 
more and more deterioration, so that eventually hospital care is 
required. It should be distinctly understood that the slight in- 
crease of symptoms which is commonly observed each month and 
of which Kraepelin .speaks ' has no reference to what is alluded to 
above and which seem to be distinct attacks. The menstrual ex- 
acerbations are but incidents in the course of the attack. 

Before attempting any further elaboration of the subject I shall 
give a few abstracts which will illustrate the above. 

Case I (No. 798) has been previously reported by Dr. Farrar ' in his 
Clinical Demonstrations. The patient is a woman, single, now aged 38 
years, who showed mental symptoms in 1890 while a student at the Pea- 
body and Maryland Institutes when 18 years old. In April she was de- 
pressed, had crying spells, soon became unfit for work and was taken home 
where she remained until August 22, 1890, when she was admitted to the 
Pennsylvania Hospital, remaining there until January 15, 1891, when she 
was discharged recovered with a diagnosis of subacute mania. She re- 
turned to her home but soon began to lose flesh and in October, 1892, 
became suspicious of her family, accused her sister of trying to poison her, 
was violent and obstinate, so that it was again necessary to place her 

' Psychiatrie, VII. Aufl. 

' Farrar, Dr. C. B. Clinical Demonstrations, i. Dementia praecox. 
American Journal of Insanity, Vol. LXII, p. 627, April, igo6. 



260 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

under hospital care, and she was readmitted to the Pennsylvania Hos- 
pital, October 27, 1892, with a diagnosis of acute mania, and was dis- 
charged recovered, January 16, 1894. 

In going over the notes made during these two attacks, which have been 
sent us, it is possible to find symptoms recorded which seem to point to a 
diagnosis of dementia precox, but it must be remembered that 18 years 
ago our knowledge of dementia praecox was considerably less than it is 
to-day, so that it is not strange that the diagnostic importance of these 
symptoms should have been overlooked. 

The symptoms recorded in the first attack are : A marked improve- 
ment in her physical condition without a corresponding mental improve- 
ment, and that she appeared feeble-minded shortly before discharge. In 
the second attack at one time she was " indifferent, silent, and unem- 
ployed," so that with a physical improvement apathy was shown, and 
dissociation between the content of consciousness and affect tone was ex- 
pressed in her statement, "I am eating dead men in their graves, I just 
love to eat them." 

The patient returned home where she apparently led an ordinary life 
but was overwrought by the care of her sick father and annoyed by a 
family with young children moving into the same house. She seemed to 
try to ward off the oncoming attack by taking up her music again and by 
attempting to give drawing lessons and by a trip from home, but all of 
these attempts were unsuccessful and she was admitted to the Sheppard 
Hospital, April 6, 1901, being talkative, confused and emotional and soon 
showed impulsivity, mannerisms, marked dissociation, and apathy, so that 
a diagnosis of dementia precox was made. 

The subsequent course has been uneventful, excepting that the patient 
has shown a periodic course, that is, there have been periods of consider- 
able excitement, corresponding with the menstrual epoch but extending 
beyond them, alternating with periods of quiet or even of partial stupor. 

In this case, therefore, we had an attack of excitement at 18 lasting for 
9 months, followed by a period in which she was almost herself for nearly 
20 months, when she had a second attack of excitement lasting about 
14 months, this being followed by a period of nearly six years during 
which she seems to have been looked upon as normal by her family. At 
the end of this remission her last attack began and at the present time has 
endured for 9 years. 

Case II (No. 1476) is a woman, single, with no occupation. 

Her family history is bad, her father and mother being first cousins. 
Her father is in the early stages of arteriosclerotic dementia and her 
mother is eccentric. Her maternal grandfather was alcoholic. A mater- 
nal great uncle was insane and had a son who was insane. Another great 
uncle's son was epileptic. 

Patient is the eighth child, was born a year after the seventh child. Dur- 
ing first year of life she was delicate. She learned to walk before twelve 



igio] WILLIAM RUSH DUNTON, JR. 261 

months old, but while teething became seriously ill, forgot how to walk 
and at 15 months had to relearn. 

In disposition she was quiet, retiring and thought to be bashful. She 
attended school from 7 until 17 and made satisfactory progress. 

Puberty occurred at 17 and was always regular until the first attack of 
mental trouble in igoo. No mental or nervous symptoms noted at 
puberty. 

Mid-February, 1900, it was noticed that the patient, then aged 22, laughed 
to herself without apparent cause, became seclusive, hypochondriacal, she 
later thought that she was an animal and that animals were in her room. 
Later she became suicidal and attempted to throw herself out of the window 
and to get a sharp instrument. She showed some posturing and has been 
untidy. She was admitted to the Sheppard Hospital April 18, 1900, and 
then first came under observation. She was quiet after a few days of 
restlessness and remained so until the ninth of May when she had 
another brief period of excitement which was thought to be premenstrual 
and it was necessary to restrain her. She showed a gradual improvement 
and was discharged September 11, 1900, as much improved. 

In this case an incorrect diagnosis was made of acute mania based 
principally upon the history before admission, but from the case notes the 
diagnosis of dementia praecox is easily made. It being noted that the 
patient was impulsive, showed mannerisms (many of these being family 
characteristics, however) some dissociation, and what we later considered 
to be apathy. 

The patient remained at home five years or until October 16, 1905, when 
she was again admitted. While at home she had led a quiet life without 
special employment, was somewhat seclusive, but did not show any ten- 
dency to suspiciousness or impulsivity, and was regarded by her family as 
having been about at her normal. She was discharged March 6, 1906, to 
be again admitted December 17, 1906, and remained under care until August 
26, 1907, during which time impulsivity became more marked and a wave- 
like condition was noted, the patient becoming excited at intervals. 

On October 6, 1907, she was again admitted, and discharged March 21, 
1908, to another hospital as her condition had evidently become per- 
manent and it would probably be impossible to ever again take her home. 

During the two years that she was at this hospital her excitement in- 
creased and she has had at least two long periods of excitement beside the 
usual shorter ones coincident with her menstrual periods. 

The last period of excitement was more marked than any preceding 
and was followed by collapse in which she died November 8, 1909. 

Case III (No. 1401) is a woman who was admitted to the Sheppard and 
Enoch Pratt Hospital May i, 1906, at which time she was single, aged 
21, and had no occupation. 

The family history is negative, but her father died 13 months after her 
admission of what was diagnosed by the two attending physicians as 
apoplexy, and as Bright's disease. 
18 



262 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

The patient is the third of four children and her birth was normal. 
She was characterized by her mother as a " right forward " child although 
it would appear that her development was neither precocious nor re- 
tarded. Her disposition was said to be bright, but quiet, not talkative, of 
an even temperament, and fond of company, especially of her own sex, 
having very few boy friends. Her health had been very good, but she had 
had one or two fainting spells when about 10 years old which her 
physician had declared to be due to heart disease, but which a physician 
who was consulted later stated had been due to indigestion. Measles and 
whooping cough at about 12 years were the only other illnesses she had 
had. School life extended from 7 to 17 years, she having graduated in 
June, 1902, and having done well. 

Puberty occurred at 13 and had been uneventful. Her periods lasted 
3 or 4 days, were regular, and only occasionally would she have to go to 
bed on account of initial pain. 

She had joined the Methodist Episcopal church at about the same time, 
but had never taken more than a moderate interest in religion. 

The patient's mother was an intelligent woman who gave all the in- 
formation possible and from her account it appeared that the patient's 
mental trouble began in the fall of 1902 when she was brought by her 
mother from their home in North Carolina to a school near Baltimore, 
where after a week she seemed perfectly satisfied, so that her mother went 
to Washington to pay a visit, where after two days she received a letter 
from the patient stating that she would die if left in the school, and the 
next day a summons was received from the principal of the school. It was 
decided that the patient should return to Washington with her mother to 
attend a wedding, and while there she showed decided mental symptoms 
and her attending physician, Dr. Ruffin, furnished us with the following 
note on her case: "She was in a condition of great mental depression; it 
was difficult to get her to respond to questions and then only in mono- 
syllables, and a circumstance which impressed me at the time and seemed 
to me to have a causative relation was that she was horribly constipated. 
I could not ascertain from her the length of time she had gone without 
operation, but the result of high enemata was simply enormous. I do not 
know that I have ever seen anything of the kind quite as marked. Her 
tongue was coated moderately, whitish in color, enlarged and indented, 
and the breath was of disagreeable odor. The pulse was of low tension, 
not decidedly accelerated, and the extremities somewhat cool to the touch. 
It was with great difficulty that she could be induced to take food. She re- 
mained in this condition from early in October, 1902, until the middle of 
March, 1903, at which time she had sufficiently recovered to be sent to her 
home. During this attack Dr. Richardson saw her with me and we con- 
sidered her condition to be a melancholia. We could assign no cause for 
its occurrence other than auto-intoxication from obstinate constipation, 
and perhaps homesickness." She lost weight during this attack but gained 
rapidly after her return home and weighed 176 pounds in June, 1903. 



igiO] WILLIAM RUSH DUNTON, JR. 263 

During the summer she showed a condition of mild excitement, riding and 
driving a great deal, and buying somewhat extravagantly. This grad- 
ually subsided and in December, 1903, she had a second attack of depres- 
sion, and was treated at her home. By September, 1904, she was able to 
visit the St. Louis Exposition with her family, took considerable interest 
in everything, and kept up with the others in all of their sight seeing. 

At Easter, 1905, the patient went to Charlottesville on a two months' 
visit to her brother who was at the University of Virginia. While here 
she again showed a mild excitement, but not of sufficient degree to cause 
her family any anxiety. She later decided that she would like to continue 
her education and came to Washington to enter a school. Two days later 
she was visited by her mother who found her sick and somewhat emotional. 
Dr. Ruffin was sent for and continues the above note as follows : " I next 
attended her in October, 1905. She was brought here with my approval to 
be placed in school with the understanding that she should do practically 
no school work. It was hoped that the absence from home and the asso- 
ciation with other girls might be beneficial. She was herself very anxious 
to be admitted to the school and looked forward to her associations with 
keen interest. She had not been there, however, more than three days 
before it was found she was rapidly developing another attack, seemingly 
similar to the first." The patient returned to her home where she re- 
mained until brought to the Sheppard Hospital. She spent the greater 
part of the time in her room, was usually depressed, but would have spells 
in which she was very talkative, and showed silly laughter. At times she 
did not wish to eat and gave as reasons that her throat was sore, that she 
had a pain in her head, etc., but was easily diverted and could then be made 
to eat well. On several occasions she was found to be soiled in the morn- 
ing, but beyond this showed no especial untidiness, and later showed an 
improvement. It is doubtful if insight was ever present. Hallucinations 
and delusions were not noted and were probably never present. Men- 
struation was absent from October, 1905, to the latter part of March, 1906, 
and on its return the patient was a little more depressed for a day or two. 
Her mother stated that after each attack she seemed a little worse than 
after the previous one, that is, she was more talkative and lively than was 
usual, and it was her belief that the patient had not been mentally well 
since before the first attack in 1902. Dr. Ruffin corroborated this, saying: 
" Since her first attack her mental tone has never been what it was before 
and it has seemed to me that there were many evidences of degenerative 
changes. Dr. Richardson and I were inclined to rather a gloomy ultimate 
prognosis, because of the lack of a distinctly adequate cause in the first 
attack." 

On admission the patient showed frequent outbursts of silly laughter, 
considerable irrelevancy in replies, dissociation, and an almost constant 
slow psychical reaction. Later she showed impulsivity. Physical exam- 
ination was normal with the exception of an increased dermatographic and 
slight increase in the triceps and ulnar reflexes. She usually wore a silly 



264 THE INTERMITTENT FORMS OF DEMENTIA PR.ECOX [Oct. 

smile, and would laugh without stimulus. Once she spoke quite 
coherently of a fall from a horse which she had recently had and of 
which no history had been obtained, and which had probably occurred at 
a more remote time or was less serious than she stated. She also showed 
some orientation as to time. The following stenographic record is repre- 
sentative of what ordinarily took place : Patient made no movement when 
physician and stenographer entered her room. 

Dr. Good morning. 

Pt. smiles. Lips are moved at the end of eighteen seconds but no sound 
is heard. 

Dr. (after one minute). What is your name? 

Pt. I don't know. 

Dr. How old are you ? 

Pt. laughs foolishly. 

Dr. (after 20 seconds). Where are you? 

Pt. Are you talking to me ? 

Dr. What is the name of this place? 

Answer inaudible. 

Dr. Are you sick? 

Pt. (whispering). Yes, I am sick. 

Dr. Are you happy ? 

Pt. smiles. 

Dr. Is there anything you want? 

Pt. makes a few movements. 

Dr. Who brought you here? 

Pt. Mother and brother. [Correct]. 

Dr. When? 

No response. 

Dr. How many days ago? 

No response. 

Dr. What day is this? 

No response. 

Dr. Do you know what year? 

No response. 

Shortly after this the patient began to complain of pains in her legs and 
in various parts of her body, that her leg was broken, that she had been 
operated upon several times, that two of her ribs were out of place. She 
pulled at her hair a good deal even pulling some out. On one occasion she 
was found striking her back and uttering such phrases as "Go call Dr. 
Dunton. My back is broken," " Tell Dr. R. he loves me so." She 
bandaged the leg which she said was broken with a towel and expressed 
other somato-psychic delusions. Two weeks after the above record was 
made she began to talk freely and an attempt was made to get a speech 
record but she talked so rapidly that it is incomplete. 

" Oh Lord ! I can almost feel it. I don't know how to read short hand. 
I don't want to read what she is writing. Forget it. * * (Dr.) When did 



IQIO] WILLIAM RUSH DUNTON, JR. 265 

you find out that you had this tumor? (Pt.) It was when I was home. 
For the Lord's sake ! He has cut me. Why, you know that I have got 
two sides to my heart. Forget it. I had this side cut. This tonsilitis 
operated on. Laudanum on this. Well, feel it. He has got to operate. 
There is a tumor on this left side. I thought I said the right side. 
Gracious Lord ! It is there. If j'ou don't stop I will die. The last 
dentist I had hurt me. I fainted so often, but if the kid comes I can't help 
it. For the Lord's sake. Ask me what doctor, I can't remember. I have 
been sailing, fishing, no I haven't. Gracious Lord, forget it. I have said 
that often, well, look here. I am about to die. I connected it right there 
because the doctor told me. For the Lord's sake. Doctor certainly cut 
me, and you want to know where. He cut me between the ribs and it bled 
so much. The next baby comes I won't believe it. Gracious Lord, I 
don't know whether it is an infant or the devil. Gracious Lord. This bad 
blood which flows through me is the devil. This tonsilitis has been 
bleeding so much, and it hurts, and the last time it bled I got the devil. Oh 
Lord forget it. Oh me." A letter which the patient wrote about a week 
later shows the same dissociation of ideas. She was somewhat resistive at 
times, was profane and impulsive and seemed to be living over the 
physical sufferings which she had experienced in the past, and when com- 
plaining of these pains her face would show an expression of great agony. 

By August there began an improvement which was progressive so that 
by the end of October she talked sensibly, but was unable to remember 
many of the occurrences of the few weeks following admission. She was 
discharged as much improved, November 6, 1906, when it was noted that 
she shows some insight, speaks of having been sick, and probably realizes 
that she is not herself as yet, but it is doubtful if she truly realizes her con- 
dition. Her reaction is fairly natural. She smiles rather foolishly, but 
usually answers questions fairly sensibly in a rather high-pitched tone of 
voice, making but little movement of the mouth and lips when speaking. 
Her mother and father considered her better than at any time since her 
first illness. 

The patient called at the hospital July i, 1907, when it was observed that 
she had grown stouter, and excepting for a childish reaction seemed to be 
perfectly well. A day or two later her father died suddenly. 

She was last seen during the spring of 1909 when she appeared to be the 
same and with the exception of the childish reaction showed nothing 
abnormal. Shortly before this her mother had called to discuss the 
question of the patient's marriage, as a young man was quite attentive and 
the mother wished to know what her daughter's future might be. At this 
time the mother seemed less inclined to consider the patient as different 
from other girls of her age. 

Here we have a young woman of 17 developing an attack of depression 
in October, 1902, which lasted for about 6 months and was followed by 
mild excitement, a second attack of depression occurring in December, 
1903, and lasting also about 8 months, an attack of excitement developing 



266 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

in the spring of 1905 and lasting about 6 months, followed by a remission 
of nearly 4 years to date, during which the patient has been better men- 
tally than at any time since the first attack. The diagnosis of this case is 
quite clear and I think we may look forward to the patient having other 
attacks with deterioration eventually so great as to require hospital care. 
One interesting point in comparison with the previous cases is the long 
remission occurring after the three attacks which came rather close to- 
gether and the deterioration appearing to her mother to be less at present 
than formerly. This last, however, would appear frequently to be due 
to the observer considering the patient's apathy to be an improvement over 
the more normal reaction when irritability is shown. 

Case IV (No. 1448) is a woman who was admitted to the Sheppard 
and Enoch Pratt Hospital October 5, 1906, she then being single, aged 
25, and a stenographer, although a part of her work was to take charge of 
a reading room several evenings each week. 

Her paternal grandfather died in 1888, aged 65, of gastric and bowel 
trouble. He had been addicted to the use of alcohol and drugs, and at 32 
had an attack of depression following typhoid. Maternal grandfather had 
died of tuberculosis at 28. With these exceptions the family history was 
exceptionally good and included a number of persons of unusual ability. 

At puberty, which occurred at 14, the patient is said to have outgrown 
her strength but no other especial change was noted. She had also suf- 
fered with nasal catarrh for years but this had improved under treatment. 
She was said to have shown a considerable degree of curiosity, and to 
have " always been childish by nature " on which account she appeared 
younger than her younger sister, but her parents would not admit that she 
was below average intelligence. She had become a stenographer in the 
congressional library, and had also been in charge of one of the reading 
rooms for three evenings a week. 

During her work in the reading room in May, 1906, she met a young 
man with whom she fell in love, but who evidently did not return her 
affection, and this outburst of affection was probably an early symptom, 
as she had previously been indifferent to men. In June she began to 
complain of nausea, then of occipital pain, and then of insomnia. The 
last two weeks of July were spent in the mountains and she slept well, but 
soon after returning to her duties she was somewhat overworked and the 
occipital pain returned. In September the insomnia became worse, she 
was "perfectly frantic at night," was emotional at times, and had lost 
weight. She expressed suicidal ideas and on one occasion said to her 
mother, " Mother, what would you do if I choked you at night ?" She 
showed self-control in the presence of strangers, which was not present 
when her family alone were present. 

Soon after admission she showed restlessness, and on physical exam- 
ination nothing abnormal but some cyanosis of the extremities, exaggerated 
knee jerks, a slight tremor of the hands and eyelids, and somewhat pro- 
longed dermatographia. Her memorv was quite good, her attention 



I910] WILLIAM RUSH DUNTON, JR. 267 

fair, but she was mildly self accusatory, claiming that she had been selfish, 
and seemed mildly depressed, and showed considerable curiosity concern- 
ing the other patients. The following record was taken: 

(Dr.) What is your name? (Pt.) My whole name is H — W — G — . 
(Dr.) How old are you? (Pt.) 25. (Dr.) Are you sick? (Pt.) 
Well, just of course this nervousness. (Dr.) Are you happy? (Pt.) 
Not so happy now, no. (Dr.) Why not? (Pt.) I would rather be 
home, I think, and at work. (Dr.) No other reason? (Pt.) Rather be 
at home and at work. (Dr.) What is your work? (Pt.) I was a 
stenographer and typewriter. (Dr.) Did you take letters? (Pt.) Yes, 
I took letters and transcribed the notes. (Dr.) What about? (Pt.) I 
was in the library and it was about magazines. (Dr.) You did not have 
many letters to write, did you? (Pt.) Many letters? No, a great deal 
was card work, I wrote letters and cards. (Dr.) How many hours a 
day were you at work? (Pt.) From 9 until 4.30. When I first went it 
was from 9 until 4. I think if I had been less selfish I would be more 
happy now. (Dr.) What is your greatest wish? (Pt.) At the present 
I think to be well and strong again. (Dr.) Do you feel weak? (Pt.) 
No, I don't feel weak. (Dr.) Do you know the name of this place? 
(Pt.) Yes, Enoch and Pratt Hospital, isn't it? (Dr.) Do you know my 
name? (Pt.) Dr. Dunton. (Dr.) How long have you been here? (Pt.) 
I came here a week ago Friday. (Dr.) Do you like it here? (Pt.) I 
am sorry to say I don't. (Dr.) What is wrong? (Pt.) It isn't just 
what I expected it to be. I thought it would be a small sanatorium. 
Everybody is very kind, though. (Dr.) Have you ever had visions? 
(Pt.) No. (Dr.) Did you ever hear voices? (Pt.) No. (Dr.) How 
much is 2X6? (Pt.) 12. (Dr.) 6 — 2? (Pt.) 4- (Dr.) 6 + 2? 
(Pt.) 8. (Dr.) 6-^2? (Pt.) 3. This is first grade work. (Dr.) 
17 + 21? (Pt.) 38 isn't it? (slow.) Dr. 143 + 198 (Pt.) I couldn't 
do it. (Dr.) 95 -H 17? (Pt.) I never could do that either without paper 
and pencil. (Dr.) What is the capital of Maryland? (Pt.) Annapolis. 
(Dr.) What is the capital of Pennsylvania? (Pt.) Harrisburg. (Dr.) 
Do you know the largest river in the United States? (Pt.) It's been 
some time since I studied, it empties into — it's the Mississippi. 

As occupation she was given some newspaper clippings to sort and 
classify in envelopes, but did it very badly. A slow psychic reaction and 
apathy were soon noticed, and some dissociation. She was taken home 
on a visit December 15th, and returned on the 29th with the report that 
she had become excited on the i8th, being profane and extravagant in 
speech, and had paroxysms in which she would tear her clothing, try to 
throw herself over the banister or out of the window, and did not sleep 
well. The next day, she was taken to a sanitarium at Forest Glen and the 
day before her return had tried to throw herself before a railway train. 
The same symptoms which have been noted were present until about the 
middle of March, 1907, when she became increasingly noisy at night so 
that it was necessary to remove her to the disturbed ward, where she was 



268 THE INTERMITTENT FORMS OF DEMENTIA PR.^iCOX [Oct. 

noisy, violent, and profane, the following well indicating her general con- 
tent of speech : 

"Won't I die? G — d — my grandmother! G — d — my mother! G — 
d — my father ! Why did they let me go to work when I was sick ? When 
I went to school, if I felt badly, my father would say, ' Don't go to school, 
for health is of more value than education,' but since I could work and 
make a penny, why it's Helen, go to work. You'll lose your position. 
A penny is worth more than your health.' Why did my mother marry 
a crazy man and have a lot of d — brats?" She masturbated a good deal 
and expressed regret that she had not gone to a " fast house " rather than 
come to the hospital. During June she became quieter, and an unfavor- 
able prognosis having been given, she was removed to a private hospital 
near Baltimore. While here she improved very much and was brought to 
the hospital by her mother, November 23, 1907, in order that we might see 
that she was almost well. And such was the impression made upon us. 
The patient was disinclined to talk of herself or her illness, but talked 
upon other topics willingly and intelligently. At times she seemed to show 
a slight apathy, losing her animation. Her improvement had been coinci- 
dent with the return of her menstruation and dated back three months. 

The patient remained at home until December 18, when after a course 
of medical treatment of eyes, nose and uterus, she suddenly became dis- 
turbed one night, but was kept at home until January 18, 1908, when she 
was returned to the private hospital, remaining there until February 28, 
when she was transferred to a private hospital in New York, from which 
she was later removed to the Government Hospital for Insane. Dr. White 
has kindly furnished me with the following note concerning her ; 

During the first two months of Miss G's stay here she was very difficult 
to manage. She was restless, and frequently had paroxysms of violence 
varying in length from two to fifteen minutes. During these outbreaks she 
would cry, shriek, throw herself about her room and the ward, beat her 
head against the wall, break dishes and furniture, pull her hair, etc. 
Her hair was always disarranged, she was very untidy in appearance and 
kept her room very disorderly. She at all times objected to taking a bath 
and protested most emphatically against treatment in the hydrotherapeutic 
department. 

She was voluble, and while her conversation showed flight and dis- 
tractibility, yet she showed a tendency to repetition, and each day followed 
the same trend of conversation which constituted fault-finding, criticism 
of her treatment here and in other hospitals, thought she was not properly 
brought up, that her relatives were insane, etc. She was at all times 
boisterous and used profane language. She was well oriented and showed 
no memory defect ; had no hallucinations. After the first two months she 
gradually became quieter and more easily managed, but showed a childish- 
ness of manner and lack of self-control. 

On November 19, 1908, she was brought before the medical conference 
for a trial visit, as her parents desired to take her to the country for one 



igio] WILLIAM RUSH DUNTON, JR. 269 

month, under the care of a special nurse. The consensus of opinion was 
that the case was atypical manic-depressive psychosis, with anomalous 
features which were suggestive of dementia praecox. She left the hospital 
on November 21 and remained in the country for two months, during 
which period her parents reported that the patient was gradually improv- 
ing. At the expiration of this time she returned to her home in the city, 
and soon thereafter she called at the hospital. She showed a marked im- 
provement and at the request of her parents her visits was extended for 
another two months. During these two months, and up to the time of her 
discharge, she came to the institution two or three times a week for treat- 
ment in the hydrotherapeutic department. We still kept her under obser- 
vation until June 28th, when she was brought before the medical con- 
ference for discharge. There was no change in the individual opinions of 
the members of the staff as to the diagnosis in this case, but it was con- 
ceded that she is of constitutional inferiority of a manic character. 

She was discharged on June 29, 1909 as recovered. Since her discharge 
she has been at her home in the city, has occasionally called at the hospital 
and the physicians who had her under their care while here have occasion- 
ally seen her at other times. Her condition has remained stationary. She 
entertains, attends social functions, and is considered by her relatives to 
be in her normal mental state. 

She has not returned to her former employment although we undersrand 
she is anxious to do so. 

Case V (No. 1981) is a woman, single, aged 35, who was admitted to 
the Sheppard and Enoch Pratt Hospital October 4, 1909. 

Patient's father was somewhat alcoholic and when over sixty had some 
sort of mental attack for which he was treated at Staunton, and recovered. 
He died at yj of apople-xy. Two sisters are somewhat nervous. 

When a baby the patient had a severe illness which is supposed to be 
the cause of her present attack, but of which no particulars could be 
learned from her brother and sisters who accompanied her to the hospital. 

Puberty occurred at 14 and was regular until her first mental attack at 
18, when 3 or 4 periods were omitted, following which it was regular until 
31- 

The patient had an attack of depression at 18 lasting about 6 months, 
but apparently recovered and took up teaching which she continued until 
30, conducting a private kindergarten between 25 and 30. The second 
attack occurred September, 1906, and lasted 6 months or more. She was 
treated at a private hospital but did not become normal until some time 
after discharge. This attack was characterized by agitation and is 
alleged to have been due to drinking sulphur water. Her next attack 
occurred during the fall of igo8. The fourth attack began about September 
15, 1909, and like the preceding one the onset followed an omitted men- 
strual period. There was no period during August, 1909, the period 
occurred September 21st, and on the 22d mental symptoms were noted. 
The onset of the attacks has usually been in the fall and recovery has 



270 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

usually taken place in February or March. Both onset and recovery are 
usually abrupt. Her sister was quite positive that there was nothing 
wrong with the patient between attacks but this seems doubtful. Man- 
nerisms, silliness, and impulsivity were marked, and the diagnosis of 
dementia prKcox was positive. She was discharged somewhat improved 
April 16, 1910. At one time her case had been diagnosed as one of 
advanced hysteria. 

Case VI (No. 1013) is a man who was admitted to the Sheppard and 
Enoch Pratt Hospital February 7, 1903, at which time he was aged 23, 
married, and a laundryman. 

The family history was negative and there was little to note in his 
previous historj'. He was steady and successful at his work, but was 
somewhat impulsive. A year before admission he complained of a queer 
sensation in his head and did not sleep well, but this was of short dura- 
tion. He smoked and chewed tobacco very freely. 

The patient was married October 29, 1902, and is said to have been 
somewhat excited previously but not sufficiently to cause any alarm to his 
family. In the evening following his marriage he went to a saloon with 
some friends, and afterwards stated that he thought he must have been 
given some knockout drops for in the morning at 3 o'clock he grasped his 
wife by the throat and was determined that she and her family should get 
up and pray. He continued to be excited and was taken to his parents' 
home. 

He was restless and excited at times, and did not sleep well. Again he 
would be mute, resistive, assumed attitudes, and showed flexibilitas cerea. 
He repeated phrases, especially those of a religious character, and was 
rambling in his talk. He showed apprehension, loss of memory, and con- 
fusion. 

On admission, while there were no striking physical symptoms he was 
not of robust physique. He showed a poor memory, imperfect orientation, 
poor judgment, weak attention and dissociation. 

The patient improved to such an extent that his friends were urged to 
give him a trial at home, and he was discharged July 2, 1903. He was 
next seen November 9, 1909, when he was brought to the Johns Hopkins 
Dispensary, at which time he showed confusion, somato psychic delusions, 
poor attention, slow psycho-motor reaction, and quite marked apathy. He 
stated that following his discharge from the hospital he had worked as a 
stevedore for 7 months, during which he had lost 35 pounds. He had then 
secured employment as a shirt ironer in a shirt factory, and had added to 
his wages by selling shirts in the evening, probably over-working and 
keeping late hours. He had three children, who with his wife are 
Romanists, and he had recently worried somewhat as to whether he 
should not join the same faith. He was kept under observation for 2 
weeks, when it being no longer possible to care for him at home he was 
sent to a state hospital. 



I9IO] WILLIAM RUSH DUNTON, JR. 27I 

The diagnosis of dementia praecox was made when the patient first came 
under observation, and the interesting point in this case is the remission 
of six and a half years during which the patient overworked and gave no 
evidence of his mental trouble. It is such cases which undoubtedly give 
rise to the belief that dementia prsecox is susceptible of cure, and from a 
practical standpoint such seems to be the case, but I believe that there is 
always a defect remaining and that ultimately the terminal stage of marked 
dementia will occur. 

The next two cases are somewhat unusual and each one has 
been the sotirce of considerable debate and of some disagreement 
as to diagnosis. 

Case VII (No. 1822) is a man, single, aged 26 when first admitted to 
the Sheppard and Enoch Pratt Hospital. He had been foreman of several 
fertilizer plants. 

The family history was apparently clear with the exception of insanity 
in three second cousins, sisters, one of whom is a case of dementia praecox, 
now in a remission of nearly 2 years, whose father has had two attacks of 
depression during his life. 

The patient did not do well in his studies and at 18 years of age went 
to Baltimore to learn the fertilizer business, remaining in this position for 4 
years or until October, 1895, when he had an attack of which the exact 
details could not be learned. He was under treatment in a general hospital 
until January, 1896, and seems to have had some sort of fever with a 
prolonged delirious attack. Following this he was idle until the summer of 
1896, when he resumed his work, but has never remained longer than two 
years in one position and cannot be said to have been more than moderately 
successful. 

In 1899, he had the first epileptiform attack. It is said these are not 
convulsions, that but 8 or 9 have recurred at irregular intervals since the 
first, and in them he has been unconscious for 20 to 30 minutes. 

Sexually, the patient has indulged to excess and has also masturbated 
since he was 14 years old. There has been no especial excesses in alcohol 
or tobacco. He has had gonorrhoea once and denies lues. 

In 1905 he was disappointed in love. The same year he again went to 
Baltimore to accept a position which he kept for but 10 days, summoning 
his father to meet him in Washington but gave no special reason for such 
a meeting. It was not until the fall of 1907, however, that his father had 
any suspicion that the patient might be suffering from any mental trouble, 
when the patient showed him plans for a fertilizer factory which were 
drawn directly contrary to those generally approved. 

In January, 1908, while at home attending his sister's wedding, he showed 
his father some poetry which he had written while on the train to adver- 
tise the fertilizer business. He also made a draft on his firm for $50, 
which his father had to honor, and soon became extravagant in his habits, 
whereas he had formerly been economical. He also began to develop 



272 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

ideas of persecution and evidently did not realize that his numerous 
resignations and changes of location had hurt his rating. 

In October, 1908, he had a series of three dreams in which the secret 
of making men in a chemical way was revealed to him, and he heard the 
voice of God telling him that he would be the Messiah if he forgave his 
enemies. " A great light had approached him and whereas he had felt 
weak and shrivelled up in all of his parts, he experienced a sudden excess 
of strength and lightness," His physician suggested that he carry out that 
part of Christ's mission which consisted of doing manual work before he 
entered on his public work, and he dug and sawed wood all day, following 
which he was quieter but spoke of his associates having monkey faces, 
apparently believing this showed their baseness. 

After admission he showed none of these delirious symptoms but de- 
scribed them and gave free utterance to his persecutory ideas. There 
appeared to be mental reduction, apathy, and in view of the foregoing 
history the general opinion was that his was a case of dementia praecox. 
One of us dissenting from the general view was inclined to call the case 
delire onirique, but personally I am of the opinion that all of the case 
reports which I have read of this form of mental trouble really are but of 
an incident in the course of dementia praecox, an opinion which I gained 
from Christian ' many years ago. 

The patient was discharged as improved December 18, 1908, and went to 
work as a shipping clerk 3 weeks later. He was laid off May I, and was 
idle until July, when through his father's influence, he secured employ- 
ment with the same company as a timekeeper and also kept record of the 
material used in the repair factory. During the period of idleness he 
worried a good deal over his inability to secure employment and at times 
appeared very much depressed. About the middle of November he began 
work on an itemized report of the cost of construction of a new fertilizer 
plant, doing this in the evening, and for about 2 months worked 16 hours 
a day. He lost weight and mid-January, 1910, showed mental symptoms, 
there being a return of his persecutory ideas. He also wrote vulgar 
poetry which he read to boys in public places, spent and borrowed money 
freely. 

He returned to the hospital March 11, 1910, as a voluntary patient, 
showed hypomaniacal symptoms and it becoming necessary to commit him, 
it was deemed best to transfer him to another hospital, which was done 
April 7, 1910. 

The majority of us still considered the patient a case of dementia 
praecox, but the physician who had made the former diagnosis of delire 
ouirique now considered him to be a psychopathic inferior plus possibly 
cyclothymia. That he was an inferior seems to me quite true, but I be- 
lieve the two attacks in which we have seen him are but stages in dementia 
praecox. 

' De la demence precoce des jeunes gens. Annales Medico-Psycho- 
logiques, Jan.-Feb., et seq., 1899. 



igio] WILLIAM RUSH DUNTON, JR. 273 

Case VIII (No. 1945) is a woman who when first admitted to the 
Sheppard and Enoch Pratt Hospital, April i, 1904, was aged 43, married, 
with no occupation. Her case is such an interesting one that it is my 
intention to discuss it more fully in a separate report and shall therefore 
merely give a brief abstract here. 

The patient's father died at 43 of dropsy, and her mother about S3 of 
brain tumor without mental symptoms. 

The patient was born in 1861, and as a child was healthy and bright. 
She had scarlet fever at 11 and a severe attack of measles at 12 years. 
At 20 years she had an attack described as brain fever, during which she 
was out of her mind for 6 months. The patient did not menstruate until 
19 and the brain fever was supposed to have been caused by her taking 
cold during a menstrual period. She was married at 23 and has had 6 
children, all of whom are healthy. The patient had nursed her mother 
during her last illness and in January, 1903, showed irritability, nervous- 
ness, excitement, restlessness, talkativeness, obtrusiveness, and some con- 
fusion. These became worse so that it was necessary to take her to a 
private sanitarium April 26th, where she remained until March 24, 1904, 
when she was taken home, but after a week it was necessary to bring her 
to the Sheppard. It was noted that the patient showed disorientation, 
irrelevancy, memory defect, irritability, negativism, suggestibility, and 
flexibilitas cerea. From January to June, 1905, she was excited, noisy, 
restless, and destructive. June 23-25 she had a scanty menstrual flow, this 
being the first since February of the same year. The patient gradually 
improved after this, but was silly in speech and behavior, her handicraft 
was poorly done, and it was noted that she showed some dementia. It 
.being thought that the patient might be able to enjoy home life for some 
months at least, she was removed September 21, 1905. 

She was readmitted November 21, 1906, having been in a fairly com- 
fortable condition until three months before, since which time her 
symptoms had gradually increased and on admission she was excited, rest- 
less, talkative, irritable and somewhat confused. She also had a few mild 
delusions of grandeur and of persecution. 

The diagnosis made during her first admission was of catatonic dementia 
praeco.x, and her present attack was considered by the majority of us as 
catatonic excitement. One of us, however, who had not seen her before 
considered her present attack as maniacal excitement. About February, 
1907, the patient began to quiet and was discharged March 30. 

She was again admitted December 29, 1907, her symptoms dating back 
about a month and being similar to those noted at her last admission. 
The excitement increased and was not affected by packs or bromide. 
About the first of March, 1908, she became fairly quiet, but was slightly 
confused, silly, and showed a tendency to assume stereotyped attitudes. 
In June this was more marked but gradually subsided and she was dis- 
charged October s. 1908. 

Her fourth admission was on July 6, 1909, her early symptoms being 



274 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

restlessness, extravagance, and the delusion that her husband was sick and 
needed hospital care. At this time she seemed to me to show a typical 
maniacal reaction, including speech compulsion, marked flight of ideas, and 
diminished reaction time, but later the flight of ideas was not so marked, 
although speech compulsion continued. By the end of September, 1909, 
she had quieted to a considerable degree and was discharged Novem- 
ber 13. 

The patient was seen December 13, 1909, she having been sent for that 
an association test might be made when she was well enough to be at 
home. This was very poorly performed and the reaction time was in- 
creased beyond normal. It was felt that deterioration was certainly 
present, and I was more positive than ever before that the case is an 
intermittent form of dementia prxcox. 

SUMMARY. 

The cases of which abstracts have been given may be briefly 
summed up as to their course as follows : 

Case I. At 18 years an attack of excitement lasting 9 months, followed 
by a remission of nearly 20 months, when there was another attack of 
excitement lasting 14 months, then a remission of 6 years, after which the 
final attack which has endured 9 years. 

Case II. At 22 years an attack of excitement lasting about 6 months, 
followed by a remission of 5 years; another attack of excitement of 4 
months, then a remission of 3 months ; another attack of excitement of 4 
months, a remission of 3 months; an attack of excitement of 8 months; a 
remission of 6 weeks, and then the final condition which required con- 
tinuous hospital care until her death 2 years and i month later. 

Case III. An attack of stupor or depression at 17 years lasting 6 
months, a remission of 8 months; a second attack of depression lasting 9 
months, a remission of 9 months ; then a brief attack of excitement, and 
brief remission each lasting 3 or 4 months; another attack of depression 
and excitement which endured 13 months and which has been followed by 
a remission of nearly 4 years. 

Case IV. A mixed attack at 25 years lasting about I year, followed by 
a remission of i month, after which an attack of excitement lasting 
about I year; then a remission lasting up to the present time, about a 
year and a half. 

Case V. An attack of depression at 18 years lasting about 6 months, 
followed by a remission of 13 years; then an attack of excitement lasting 
about 6 months, a remission of 2 years and 6 months, and a final attack 
of excitement from which the patient is now convalescing. 

Case VI. At 23 years an attack of excitement lasting about 6 months 
and followed by a remission of about six and a half years, after which 
there ensued a depressed or confused stage which is now in progress, but 
which I believe is the beginning of the terminal stage. 



igio] WILLIAM RUSH DUNTON, JR. 275 

Case VII. At 22 a delirious attack lasting probably 3 months. A re- 
mission of 14 years, when at 36 there was an attack of mild excitement with 
delirious symptoms. About a year after the patient had a return of the 
same symptoms and is still in this attack. 

Case VIII. An attack of brain fever at 20 lasting 6 months. At 43 an 
attack of excitement during the latter part of which catatonic symptoms 
were present. This attack lasted 2 years and 9 months, and was followed 
by a remission of 14 months. The next attack was also of excitement and 
lasted about 7 months. Then occurred a remission of 8 months, followed 
by an attack of excitement lasting 11 months, during which catatonic 
symptoms were present. After a remission of 9 months there was an 
attack of excitement of 4 months. At the present time. May i, 1910, the 
remission has lasted 6 months. 

While a number of other cases might be given, probably the 
above will sufficiently illustrate what is meant by the intermittent 
form of dementia prseco.x. We see that while these cases differ 
in inany details they all follow a certain course which, I believe 
serves to differentiate them into this subgroup. That is, after an 
initial attack which is more or less typical of dementia prgecox, 
there is a remission in which the patient may seem to have nearly 
reached his normal. This is followed by other attacks of aliena- 
tion and remissions of variable duration after which the terminal 
stage of dementia ensues. In many of these cases the diagnosis is 
yery difficult at certain times, as they so nearly resemble cases of 
maniacal-depressive insanity in their excitement or depression, 
and even in the remissions the presence of abnormal symptoms 
may only be detected by the application of psychological tests for 
association, memory, attention, computation, etc., as ordinary, 
every-day contact shows nothing abnormal. It is on this account 
that we find different observers of the same case disagreeing on 
the diagnosis, as in Cases VII and VIII, or making a combination 
diagnosis, as " atypical manic-depressive psychosis, with anoma- 
lous features suggestive of dementia prsecox," as in Case IV, or 
" dementia prsecox, having exhibited itself especially in paranoid 
and hebephrenic symptoms, but influenced largely by a periodic 
manic-depressive activity " as in another case not here presented. 

This difficulty of diagnosis can be easily understood by one who 
has studied cases of this form and seems to me to point to a closer 
relationship between the maniacal-depressive psychosis and demen- 
tia prsecox than most of the followers of Kraepelin have been 



276 THE INTERMITTENT FORMS OF DEMENTIA PR.ECOX [Oct. 

willing to hitherto admit, and to which attention was directed in 
my previous paper on the cyclic forms. 

It can be easily understood in many of these cases that the 
importance of their recognition from a prognostic standpoint is 
great, and by lessening the intellectual strain of an occupation or 
by changing to one mentally less arduous, the remission may be 
prolonged, and the dementia arrested, as has been pointed out by 
Dr. Jelliffe.' 

I regret that I do not feel qualified at present to speak positively 
concerning the symptoms which are of diagnostic and prognostic 
importance excepting to say that they are those of early, or pre- 
dementia prsecox, and as a prophylactic measure if we find symp- 
toms which are suggestive of dementia prascox the life of the 
patient should be so arranged as to reduce mental strain to a 
minimum. 

In contrast with the cyclic form the intermittent form does not 
show such regularity of course and of symptoms as does the for- 
mer, or in other words there is no fairly well-marked cycle. The 
intermittent form shows a great irregularity both in course and 
symptoms and it is impossible to say how long either remissions 
or attacks will last as is possible with the cyclic form. 

I know of but one writer who recognizes the intermittent form 
as a definite subgroup of dementia praecox, and this is Dr. Wieg- 
Wickenthal, of Halle, who, in his pamphlet " Zur Klinik der De- 
mentia Prjecox," ° makes the unusual grouping into : 

1. Hebephrenia and catatonias. 

2. Cases with hysteriform-neurasthenic onset. 

3. Cases with a depressive-paranoid cause. 

4. Cases beginning with marked confusion. 

5. Cases with intermittent course. 

6. True paranoid cases — " dementia paranoides." 
Of the intermittent form he says : 

" I come now to a broader group of the dementia praecox psychoses 
which are characterized by their intermittent course. In these cases re- 

'Jclliffe, Smith Ely. The Signs of Pre-dem.entia Praecox: Their Sig- 
nificance and Pedagogic Prophylaxis. American Journal of Medical 
Sciences, CXXXIV, p. 107. 

•Halle, 1908, Carl Marhold. 



igio] WILLIAM RUSH DUNTON, JR. 277 

missions or exacerbations or the same mental disturbance alternate. The 
course of these psychoses is characterized by repeated attacks. These 
attacks sometimes resemble each other more or less, or different forms of 
psychic disturbance succeed each other at each psychic phase of the illness. 
The most important types of these attacks are the circular (manic-de- 
pressive) for these may assume the form of a periodic pseudo-mania, and 
finally the periodic or repeated catatonic state of disturbance and confusion. 
In many cases, as has been said, the single attacks of psychic disturbance 
differ entirely from each other. The psychosis begins for example, with a 
condition of confusion which passes off after a tim.e and is succeeded by an 
apparent recovery, but very often after an initial attack of this sort there 
remains a change in the disposition or character of the patient. After 
several months the scene is again opened by a stupor, which may be later 
followed by a hebephrenic condition which leads very often to the first 
definite weakmindedness. A whole series of such combinations may be 
met with in practice." 

It will be noted that the above description is applicable to the 
cases of which abstracts have been given. 

It is also of interest to note what G. Deny and P. Roy, in their 
little book on " Dementia Prsecox," say regarding remissions : 

" If cures are rare and perhaps doubtful, on the other hand, remissions 
are frequent and sometimes sufficiently marked to allow the patient to re- 
sume their previous occupations and gives to their friends illusion of a 
cure. Actually only the acute phenomena (delusions, catatonic symptoms, 
crisis of excitement, etc.), are susceptible of improvement, the psychic 
defect remaining unchanged. There is nearly always present in the course 
of these remissions certain signs of chronicity, irritability, mannerisms, 
tics, and affected and bizarre conduct." ' 

Believing as I do that Kraepelin's description of dementia 
praecox applies to a large group of cases and that our knowledge 
of mental diseases will be increased by a separation of cases into 
a number of groups and a more minute study of them, I am not 
in sympathy with those who advocate the restriction of the term 
to the hebephrenic form nor with those who apply the term to a 
large group without further differentiation. It seems to me that 
the cyclic form previously described is a subgroup of this intermit- 
tent form and that they seem to point to a middle ground between 
the maniacal-depressive and dementia-praecox groups. It is on 

'La Demence Precoce; G. Deny et P. Roy, Paris, 1903, Librairie J. B. 
Balliere et Fils. 

19 



278 THE INTERMITTENT FORMS OF DEMENTIA PRECOX [Oct. 

this account that I believe that considerable study may be profit- 
ably given to these cases and by it we may eventually be able to 
differentiate mania and pseudo-mania, mild apathy and depression 
more easily than we can at present, probably by bringing to light 
symptoms which are at present overlooked or put aside as of slight 
importance. It is also very probable that by an increase of our 
knowledge of these last-named groups that we shall be obliged 
to change some of our present conceptions of them. 



SIMULATED FOOLISHNESS IN HYSTERIA* 

By ERNEST JONES, M. D., M. R. C. P. (London), 

Demonstrator of Psychiatry, University of Toronto; Clinical Director of 
the Ontario Clinic for Nervous and Mental Diseases. 

The word " simulation " is involved in so many misunderstand- 
ings and divergent meanings that whenever it is used it is de- 
sirable to define it, even when, as here, it is not intended directly 
to discuss the main problems concerning the relation of it to 
mental abnormality. The two chief connotations of the term in 
medicine are: (i) the conscious and purposive feigning of a 
given symptom with the intention of deriving a palpable benefit 
therefrom, and (2) the deceptive resemblance that one symptom 
may bear to another. The extreme types of these are easily to 
be distinguished. An example of the first would be the deliberate 
feigning of insanity in order to escape punishment for a crime ; 
of the second, the " simulation " of bronchiectasis by an unusual 
form of pulmonary tuberculosis. There are, however, many dif- 
ferent kinds of cases in which the distinction is by no means so 
obvious, and is sometimes, indeed, almost impossible to make ; this 
is particularly so in the simulation of mental symptoms. It is 
occasionally a very difficult matter to decide whether the simula- 
tion of a mental symptom not really present is due to deliberate 
design, or to the effect of another, and unsuspected, disorder that 
is operating independently of the patient's will. The two criteria 
that are naturally first thought of, namely whether the patient is 
conscious of the simulation and whether he has anything to gain by 
its occurrence, are open to many sources of fallacy. Awareness 
on the part of the patient in no way demonstrates deliberate pro- 
duction of the symptom, nor is it always present at a given moment 
even in cases of this nature. Again, a symptom that occurs quite 
independently of the patient's will may be distinctly welcome to 
him and of considerable benefit, while on the other hand the ad- 

*Read before the Detroit Society of Neurology and Psychiatry, February 
3> 1910. 



28o SIMULATED FOOLISHNESS IN HYSTERIA [Oct. 

vantage accruing from the deliberate feigning of a given symptom 
may to the observer appear to be quite incommensurate with the 
drawbacks and suffering endured. 

From the extensive and excellent work ' that has in recent years 
been done on the subject of simulation of insanity some conclu- 
sions stand out with peculiar distinctness. Of these the following 
may be mentioned : Deliberate simulation of insanity is a rare oc- 
currence, much more so than was previously thought ; in the cases 
of this nature the great majority of the patients show positive 
mental disorder, most frequently feeble-mindedness, hysteria and 
dementia prsecox ; deliberate simulation is commonly the product 
of motives that in their quality or intensity show marked devia- 
tion from the normal, and is an undertaking very difficult for a 
healthy person to sustain for more than a short time. 

In the psycho-neuroses, and especially in the case of hysteria, 
the problem is even more complex. Purposiveness and imitation 
are attributes so easily ascribed to hysteria by superficial con- 
sideration that it is little wonder that it has taken thirty years' in- 
vestigation to convince neurologists that the symptoms are not 
the product of conscious deception. This conclusion, certain as 
it is, has up to the present been only partially assimilated by the 
medical profession at large, which still talks of " detecting " hys- 
teria almost as often as of diagnosing it. Some of Freud's recent 
work may, when imperfectly understood, have the effect of rein- 
forcing this ancient error; I refer to his demonstration that each 

' See particularly Becker : Beitrage zur Lehre von der Simulation und 
Aggravation bei traumatischer Neurose. Kiel, 1906. Die Simulation von 
Krankheiten und ihre Beurteilung. Leipzig, 1908. Ueber die Bedeutung 
der Sommerschen Untersuchungsniethoden fiir die Frage der Simulation. 
Aerztl. Sachverst.-Ztg., 1908, Nr. 19. Ueber Simulation von Schwachsinn. 
Klinik f. psych, u. nerv. Krankheiten, Bd". IV, S. 69, u. 85. Bolte: Ueber 
einige Falle von Simulation. Allg. Zeitschr. f. Psychiatr., Bd. LX, S. 47. 
Bonhoffer: Klinische Beitrage zur Lehre von den Degenerationspsychosen. 
Halle, 1907. Bresler : Die Simulation von Geistesstorung und Epilepsie. 
Halle, 1904. Jung: Ueber Simulation von Geistesstorung. Journ. f. 
Psychol, u. Neur., Bd. II, S. 181. Koppen: Ueber die Entlarvung von 
Simulation bei Geisteskranken. Deutsche Med. Woch., 1907, Nr. 24. 
Mairet : La simulation de la folic. Montpelier, 1908. Peuta : Die Simu- 
lation von Geisteskrankheit. Wiirzburg, 1906. Raimann: Simulation von 
Geistesstorung, 1907. Riehm: Zur Frage der Simulation von Geistes- 
krankheit. Allg. Zeitschr. f. Psychiatr., Bd. LXV, S. 28. 



1910] ERNEST JONES 281 

hysterical symptom does in fact have a meaning, in a sense a pur- 
pose, and serves the function of gratifying an egoistic aim of the 
patient's. He holds that a hysterical symptom is the symbolic and 
distorted expression of the fulfilment of a " repressed " (ver- 
drcingt) wish, that it is the only means open to the patient of ob- 
taining a secret pleasure/ There is, however, this important diflfer- 
ence to be noted between Freud's conception and the current view, 
namely that, according to him, the whole process always takes its 
roots in the unconscious, and is usually unconscious tliroughout ; 
both the wish and the gratification are unknown to the patient. 
That is the reason why urging the patient consciously to overcome 
the symptom meets with such limited success. It is only when the 
underlying process is made conscious that it becomes within the 
patient's power permanently to overcome the symptom. 

The symptom of foolish, silly behavior has long been recognized 
as a frequent one in hysteria, and is often thought to be character- 
istic of the mental state of this malady. Only a few observers, 
however, have noted how closely allied it is to another, equally 
frequent, mental trait, namely childishness. This latter trait, 
when prominent, has been given the special name of moria. Prac- 
tically nothing had been contributed to the elucidation of the ob- 
scure symptom in question until the adoption of Freud's psycho- 
analytic method, so that the numerous references to it in the 
literature need not be dealt with. It is hoped that the following 
case may throw some light on the nature and origin of it, as well 
as illustrating the difficulties in diagnosis that its presence may 
give rise to. 

The patient, a boy of 15, was kindly transferred to my care by 
Dr. C. K. Clarke on September 20, 1909. He was then suffering 
from attacks of a peculiar kind that will presently be described. 
The history was that he had been quite well until two months 
before. On July 21, when at work, he was hit on the head by a 
number of bobbins which he was piling up above him. He was 
slightly stunned, but went on with his work. That night he 
seemed to be a little out of sorts, and lay quiet, curled up on the 
hearth rug. On July 25 his mother first heard about the acci- 

' Freud: Selected Papers on Hysteria. Transl. by A. A. Brill, New- 
York, 1909, Ch. IX and X. 



282 SIMULATED FOOLISHNESS IN HYSTERIA [Oct. 

dent, and on the next day she took him to see a doctor. During 
these five days the boy's behavior had quite changed, in that he 
had become moody and sulky, refused to speak to anyone, and re- 
sented answering questions addressed to him. The doctor sent 
him into the hospital, where he rapidly became very excited and 
even delirious. That night he was extremely restless, had to be 
held in bed, and did not recognize his mother. The doctor said 
that he had brain fever, and had his head shaved. On the next 
day his mother took him away from the hospital, but he continued 
in the same excited and restless condition for about ten days. 
During this time he was very noisy and obstreperous, and they 
had difficulty in feeding him or in getting him to answer any ques- 
tions. He gradually recovered, but had never been quite well 
since. In the succeeding two months he suffered from attacks that 
regularly recurred every ten days. In these he behaved in an ex- 
ceedingly foolish and childish manner, restlessly wandered about 
the house whistling, played silly pranks, and teased his brothers 
and sisters, using rough horseplay ; he would slap them until they 
got annoyed, and then would hug and kiss them to excess. On 
two occasions he got into a wagon that was outside the door, and 
aimlessly drove off. He could give no explanation of all these 
actions, and could with difficulty be persuaded to talk. One curi- 
ous feature, the significance of which we shall see later, was that 
he kept avoiding his father, with whom he had previously been on 
good terms, and that when his father addressed him he would in- 
stinctively put up his arm as if to guard from a blow. In between 
these attacks, which lasted about ten days each, he did not return 
to his normal state, but continued to behave in a peculiar, foolish 
and childish manner, though to not such a marked extent. He 
would often be afraid to go to the closet alone, even in broad day- 
light, and would insist on his mother accompanying him. Again, 
he would make only the feeblest efforts to wash himself, so that 
his mother had to do this for him as if he were a child. He slept 
well, and his appetite was good, though very capricious. 

When I saw him the most noticeable feature was his appar- 
ently foolish stupidity. He giggled in a curious silly way, and 
his behavior was throughout asinine. He refused to speak, and 
answered questions, in a monosyllable, only after repeated en- 
quiries. He had some slight headache, which was general and 



I9IO] ERNEST JONES 283 

continuous. I was struck by the incongruity between the slight- 
ness of the accident and the apparently grave consequences of 
it. The bobbins weigh only nine ounces each, and had left no 
mark on his scalp. There was not the slightest evidence or proba- 
bility of any fracture of the skull, and on careful neurological 
examination no abnormal physical signs whatever could be made 
out. The question of diagnosis was at this stage by no means 
an easy one, for the boy's mental state closely resembled that 
found in the stage of recovery from cerebral irritation due to 
physical trauma. However, for the reasons just stated, I felt that 
the remarkable symptoms could hardly have been produced by 
an organic lesion, decided that the case was probably one of hys- 
terical automatism, and advised psycho-therapeutic treatment. 

On his next visit he was in one of what his mother called his 
bad spells. In an interview of nearly an hour I never once got 
him to speak or answer me. He ignored my questions except 
that he occasionally gave a silly giggling smile. As a rule he sat 
there stupidly, and would not co-operate in the examination. When 
one tried to test his reflexes he resented it like a timorous child 
who does not understand what is being done. After a while he 
began to blubber and cry, and tearfully clung to his mother's skirt. 
This culminated in his bellowing " Want to doe home ; Turn home 
with me." He absolutely refused to be soothed by either his 
mother or me. and behaved like an inconsolable baby, so that 
finally she had to take him home. The speech alteration accorded 
well with his babyish behavior, for it is well known how char- 
acteristic of early childhood speech is the replacement of posterior 
linguo-palatals by the corresponding anterior ones. 

It will be seen at this point that the patient had relapsed into 
the mental state of a child about four years old, and was acting 
throughout in correspondence with this. Partial disaggregation 
had occurred of his later memories, which had lost their normal 
vividness and significance, and in his phantasy he was living over 
again the time of his early childhood. As was mentioned above, 
this is an occurrence by no means rare in hysteria. One of the 
first descriptions of it was given, under the name of " etat sur- 
naturel d'enfance," by de Mongeron,' who writes : " On voit tout 

' Carre de Mongeron : Quoted by Calmeil. De la folie, Paris, 1845, t. 
II, p. 390. 



284 SIMULATED FOOLISHNESS IN HYSTERIA [Oct. 

a coup tin air enfantin se repandre sur leur visage, dans leurs 
gestes, dans leur ton de voix, dans I'attitude de leur corps, dans 
toutes leurs facons d'agir, et quoique leurs convulsions leur fassent 
faire alors des mouvements a la facon simple, innocente et timide 
avec laquelle ils enoncent leurs pensees ; neanmoins, cet instinct 
leur fait souvent dire bonnement des verites tres fortes." It is 
one form of the syndrome described in 1882 by Pitres under the 
name of ecmnesia, which he defines * as a partial retrograde am- 
nesia with reversion of the personality to that corresponding with 
an earlier period of life. He relates the case ° of a girl of twenty- 
eight who passed into a delirious state in which she fancied her- 
self seven years old, and acted accordingly ; this case and the 
symptom were fully discussed by one of his pupils in a thesis ' 
devoted to the subject. A classic instance of the condition is the 
famous case Louis V, studied by many observers.' Pitres first 
pointed out,' and it has frequently since been confirmed, that the 
condition can in some cases be artificially brought about in hyp- 
nosis, a fact well illustrated by the production of the personality 
Sally in Morton Prince's Miss Beauchamp case.' 

That the symptom of simulated foolishness {Dummstellen) was 
in the present case intimately connected with the infantile form of 
ecmnesia is evident when the detailed features of it are more 
closely studied. The foolishness showed all the characteristics of 
childishness, namely complete irresponsibility, apparent purpose- 
less naughtiness for its own sake, absurdity, silliness and almost 
imbecile ignorance. Following Freud, I have elsewhere '° pointed 

* Pitres : Lecons cliniques sur I'hysterie. Paris, 1S91, t. II, p. 219. 

"Ibid: Op. cit., p. 292. 

' Blanc-Fontenille : Etude sur une forme particuliere de delire hys- 
terique (delire avec ecmnesie). Th. de Bordeaux, 1887. 

' Camuset : Un cas de dedoublement de la personnalite. Periode 
amnesique d'une annee chez un jeune hysterique. Annales med.-psychol., 
Jan., 1882. Jules Voisin : Note sur un cas de grande hysterie cliez 
rhomme avec dedoublement de la personnalite. Arch, de Neurol., 1885, 
t. I, p. 212. Berjon: La grande hysterie chez Thomme. Th. de Bor- 
deaux, 1886. Bourru et Burot : Variation de la personnalite. Paris, 1888. 

'Pitres: Op. cit., p. 221. 

' Morton Prince : The Dissociation of a Personality. New York, 1906. 

" Amer. Journ. of Psychol., January, I910, p. 3. 



I9IO] ERNEST JONES 285 

out that the occurrence of this particular form of foohshness some- 
times seen in hysterical adults has its exact counterpart in the 
fits of exaggerated childishness at times indulged in by some 
children. These fits when pronounced are often the prelude to 
nervous giggling, uncontrollable laughing or outbursts of weep- 
ing. The motive actuating the behavior of these children is to 
delude their elders into regarding them as being " too young to 
understand," and into, therefore, ignoring their presence. The 
reason for this artifice is that they may by means of it overhear 
or see various private matters that they are not supposed to. 
When a mother chats with her intimate friends over various 
private topics, frequently the child will resort to the strangest de- 
vices in order to stay in the room and listen to the conversation. 
Then when someone remarks him, and by her look insinuates a 
doubt as to the propriety of conversing in his presence, he will 
interrupt his innocent crooning over his toys and indulge in ex- 
aggeratedly foolish antics, to disarm, as it were, the suspicions of 
the company by convincing them of his thorough simple-minded- 
ness and innocence ; such children are not always so innocent as 
they appear. It need hardly be said that this curiosity is in most 
cases concerned with matters of a directly sexual nature, such as, 
for instance, obstetric topics ; indeed, there is no doubt that 
. children in this way overhear and even witness marital embraces 
far more frequently than most parents suppose, often with very 
harmful consequences. Psycho-analysis of infantile memories re- 
veal the remarkable frequency with which the subject had passed 
through such experiences when in the same room as their parents, 
or in an adjoining one. The gratification of sexual curiosity may 
in many complex ways greatly influence the phantasies of children 
at a surprisingly early age, a remark that no doubt will appear 
strange to those who do not realize how much richer and more 
extensive is the psycho-sexual life of young children than, through 
" repression " and later amnesia, appears to be the case. 

To return to consideration of the present patient. For unavoid- 
able reasons I was unable to carry out a full psycho-analysis, but 
analysis of the actual symptom in question had the result both of 
elucidating the psychogenesis of it and of thereby removing it. At 
first the patient disclaimed all knowledge of sexual matters, and in 
an automatic parrot-like way said that " doctors brought the 



286 SIMULATED FOOLISHNESS IN HYSTERIA [Oct 

babies," a belief obviously inconsistent with the information 
usually possessed by a boy of his age and class. It soon came out 
that he not only had the fullest knowledge of the subject, but had 
passed through a number of sexual experiences. Further, he was 
able to recall having at the age of four or five experienced sexual 
excitations in his mother's caresses, and having at different times 
indulged in various improper phantasies about her. The uncon- 
scious motive of his present delirium was. by feigning the helpless- 
ness of a child, to obtain a repetition of his old intimate relation 
with his mother, to get taken into her bed and nursed, to be washed 
and otherwise cared for by her just as a child; he had even in- 
sisted on her accompanying him to the closet and arranging his 
clothes. The guilty dread of his father, which was mentioned 
above, arose from his jealous dislike" that he had as a child felt 
towards him in relation to sleeping with the mother. His violent 
outburst in the hospital was occasioned by the fact that he had for 
medical reasons been placed in an isolation ward which happened 
to have barred windows. He was terrified whenever he caught 
sight of the bars, for his guilty conscience gave him the idea that 
he had done something wicked and had been put in gaol. 

After a few weeks' treatment he recovered, went back to work, 
and has been quite well ever since. 

" See a development of this subject in the Amer. Journ. of Psychol., 
January, igio, p. 96, et seq. 



THE SIMULATION OF HYSTERIA. 

By TOM A. WILLIAMS, M. B., C. M. (Edin.), 

Neurologist to Epiphany Free Dispensary, Washington, D. C; Memb. 
Corresp. Etrang. Soc. de Neurol, de Paris; Memb. Corresp. Etrang. 
Soc. de Psychol, de Paris; Memb. Assoc. Soc. Med. Ment. Clin, de 
Paris. 

Tardieu well said, " It is only by profound knowledge of the 
reality that it is possible to recognize its simulation." The fol- 
lowing case is presented in illustration of this thesis. Further- 
more, although a great many ruses have been used to unmask a 
simulator by spying and by methods often called " the third 
degree," the best procedures of all are those which depend upon 
the doctor's knowledge of the signs and evolution of disease. 

This statement is particularly true with regard to hysteria; 
for that psychosis is one of such apparent variability that, if the 
concept of the doctor is vague, there is little chance of reaching 
precision in the diagnosis. 

• Unfortunately the concept of hysteria still possessed by most 
medical men is far from precise.' The study of cases by a rig- 
orous neurological technique has not received in this country the 
attention it merits, and which it has received more particularly in 
France, and more especially since Babinski'' first made a breach 
in the beliefs which had ruled in the days of Charcot. His keen 
powers of observation and skilful neurological technique had dis- 
covered the artificiality of much of the hysteria in the Salpetriere; 
and the kind of analysis of symptoms which he has inspired has 
now removed from the domain of hysteria very many conditions 
which were formerly included within it.' Such were restriction of 
the visual fields and dyschromatopsia ; abnormalities of the skin 
and tendon reflexes ; vasomotor and trophic disturbances, such as 
oedema and skin eruptions ; pupillary irregularities and inequali- 
ties. Nor is the temperature modified hysterogcnically ; and the 
urinary, sudoral and salivary secretions are not altered per se by 
the psychic state which we call hysteria. 



288 THE SIMULATION OF HYSTERIA [Oct. 

However, hysteria is sometimes manifested in consequence of a 
physical alteration which affects the neurones. In that case, the 
same physical alteration may be productive of functional perturba- 
tions of the lower neurones too, and there may accompany the 
hysteria exaggerated reflexes, trophic perturbations, and circula- 
tory irregularities. Furthermore, the physical malady in question 
may manifest itself by fever and its accompaniments of perturbed 
secretion. But these themselves are not hysterical ; for hysteria 
may, can and does occur without any physical disturbances what- 
ever. 

Hysteria then is merely a mode of reaction of the nervous 
system. It is purely mental, psychic ; and it is determined by 
purely psychic causes. Even when it occurs in consequence of 
physically disturbed neurones, it is the psychic stimulus which 
arouses the particular symptom which we call hysterical in that 
case. The organic disease merely increases the susceptibility to 
react in the way we call hysterical. 

But there are a great many ways of mental or psychic reaction ; 
and hysteria is only one of these. How then shall we define and 
characterize that one ? As I have discussed this question at great 
length elsewhere,* I shall not do so further here, but simply adopt 
the conclusion which declares that by a hysterical symptom we 
mean " one which is susceptible of production by suggestion and 
of removal also by suggestion." ° 

Against the adoption of this definition, much has been urged, 
especially by alienists, who have confused with simple hysteria 
the compound clinical pictures, which are so common, where hys- 
terical symptoms are only part of another psychosis. The analy- 
sis of mental symptoms is much more complex that that of neu- 
rological signs ; and unfortunately no clear and honest discussion 
of this matter has yet occurred, such as so much clarified neuro- 
logical hysteria in Paris in 1907.° I fear that the time is hardly 
ripe for such discussion ; for few alienists are capable of viewing 
the problem ; as they are unfortunate in not seeing cases at their 
inception and during their evolution, at which time can best be 
appreciated the pathogenesis, before it becomes masked by the 
complications of commitment and asylum life. Besides, the alien- 
ists' interests are turned towards determination of mental un- 



IQIO] TOM A. WILLIAMS 28g 

soundness : questions of psychopathology are studied only by the 
few. 

To the practitioner and neurologist in the past, the chief pit- 
fall has been the tendency to confound with hysteria all psycho- 
neurotic conditions. Recent work, however, has given us criteria 
of ready clinical applicability, and these are laid down elsewhere.' 

Another common fallacy is to call emotionalism hysteria : they 
are really very different. Emotion is as a rule evanescent when 
determined psychically, and is always so unless maintained idea- 
tionally. This question has also been recently considered at the 
Paris neurological society in conjunction with the society of psy- 
chiatry," and also by the writer from a different aspect, before the 
Southern Society of Psychology." 

In relation to malingering, some recent authorities believe that 
the hysterical attitude, whether induced or autogenetic, is in 
reality a simulation, although an unconscious one.'" The question 
is too complex for discussion here, as the psychological ramifica- 
tions to which it leads do not seem to the writer capable of solu- 
tion at present. Moreover, '' restriction of the field of conscious- 
ness " " is a normal accompaniment of every effective concentra- 
tion of mind ; and indeed the acquirement of this power is one of 
the objects of education. " The suppressed complex " " is a phe- 
nomenon which few escape ; but in only a few does it produce 
hysteria or other psychosis. Its role is still sub jtidice. At all 
events, its catharsis " is not recognized as an essential therapeutic 
arm, and indeed many of us believe that other means are not only 
simpler but more effective. 

An Illustrative Case of Simulated Hysteria and Mental 

Debility. 

The patient was a young negro accused of murdering his wife, 
seen in consultation with Dr. Shute, the jail physician, on account 
of a suspicion that he was a case of dementia pr.-ecox. I was in- 
formed that some physicians believed him hysterical, and that 
others thought he was suffering from syphilis of the nervous 
system. 

On examination, I found a well developed man who showed no 
abnormalities of motility. 



290 THE SIMULATION OF HYSTERIA [Oct. 

REFLEXES. 

The knee-jerk was made very violently (the explanation of this 
will appear) ; but there was no corresponding excessive reaction 
on tapping the tendo-achilles, nor was there extension of the great 
toe when the sole was stroked. The abdominal, cremasteric and 
conjunctival and pupillary reflexes were present and equal. 

SENSIBILITY. 

His Suspidousiiess. — He was very unwilling to close his eyes 
for my examination of the sensibility ; and when touched by wool 
on the right side, opened them and jumped in alarm. He stated 
that he could not feel at all on the left side ; but all his responses 
were made after much delay, and he was evidently suspicious and 
alarmed. The sense of attitudes was not lost ; for though he pre- 
tended not to know in what position I had placed his left foot, 
he imitated that position when asked to do so. He declared that 
he could not feel the increase as I gradually augmented to 15 
kilograms my pressure on the left shoulder. As he was unsup- 
ported and in the upright position, he must have been conscious, 
at least, of the muscles of the opposite side acting to maintain his 
attitude. Of course, even had the impulses from the muscles on 
the affected side been interrupted, as he pretended, the sound side 
would have detected the pressure ; but he persistently declared 
that he felt nothing at all. 

The diagnosis of simulation was clinched by the fact that 
though he pretended not to feel a pin-prick anywhere on the left 
side, yet when I distracted his attention by making him examine 
some pictures " I had brought to elucidate his mental state, and 
jabbed him unexpectedly with a pin in the lower part of the left 
chest, he not only started violently, but he placed his hand over 
the spot, and first looked down and then at me. As I gave no 
sign, he slowly returned his eyes to the examination of the picture. 
The visual fields were not contracted. 

As to his mental state, though it was apparently very dull, the 
stupidity he affected did not concord with the results of the tests 
I made. When I asked him how long he had been in jail he pre- 
tended with a vague stare not to know, eventually saying, " Two- 
three years " (he had only been a few weeks). 

By adopting a matter-of-fact manner and ignoring his expecta- 



igiOj TOM A. WILLIAMS 291 

tions of meeting with a naif credulity to which he had evidently 
been accustomed, I succeeded in learning that he had been foot- 
man to a gentleman in the Department of Commerce and Labor, 
who lived in a hotel and who kept a white maid and a colored 
coachman who lived out. He did not admit, however, the remem- 
brance of his name. His intelligence was thus of too low a grade 
even to pretend a tenable amnesia. I then showed him the pict- 
ures, in which at first he pretended not to recognize a tree ; but 
later he saw the absurdity of his first statement that a man was 
holding in his hand a stick, when in reality it was a hose from 
which water was issuing ; for he not only saw the absurdity when 
told, but detected the break in the hose. My experience shows 
that not every individual, even of good intelligence, detects this 
discrepancy. In another case, he recognized that a horse pulling 
a sled up hill was not properly hitched, the chain not being taut; 
this discrepancy is rarely detected by patients. He thus showed 
a power of perception utterly at variance with the stupidity he 
alleged to me and to previous observers. Some weeks later, he 
was said to have contracture of visual fields. On examination, 
he again alleged hemiansesthesia ; but I again tripped him up on 
one occasion, although several methods failed, on account of his 
previous experiences. However, he ultimately confessed to feeling 
pinches on the back of his hand. He related various events to me 
quite clearly and accurately. 

Being given the benefit of a doubt which should not have ex- 
isted, he was sent to the asylum ; and I am informed that now he 
shows no somatic symptoms, and merely the mental state of be- 
longing to a low type of intelligence without any psychosis. 

I should add that the hemianaesthesia presented the characters 
of the hysterical type," that is to say: (i) it was absolute; (2) 
affected all segments equally, and (3) reached the mid-line ex- 
actly. Whether its source was in medical suggestion or simple 
simulation could not be ascertained ; for of course the patient did 
not confess ; and the numerous medical examinations which had 
been made without the precautions upon which Babinski " has 
insisted afford a strong presumption of suggestion of medical 
origin ; for it is the commonest source of anaesthesia of this type. 
The exaggeration of the knee-jerks was a voluntary one, and can 
be easily simulated, as anyone can prove by trying it. This mode 



292 THE SIMULATION OF HYSTERIA [Oct. 

of reaction can be detected by an experienced observer. It prob- 
ably was the result of the interest shown in it at the first ex- 
amination. 

THE GENESIS OF SIMULATION IN HYSTERIA. 

The case was clearly then, one of simulation from desire to 
avoid punishment for the crime he had committed. The form in 
which the symptoms manifested themselves was determined by 
the faulty technique in previous medical examinations. The fault 
was similar to that stigmatized by Soury " when he criticized 
Rainaldi's " localization of cortical centers in conformity with the 
symptoms manifested when he tapped different points of the 
crania of patients during hypnotism : " The symptoms corre- 
sponded with the text-books which the different experimenters 
had read." What the observers had described was the result of 
their own suggestions. 

And so it was in this case, both for the hemianassthesia and 
the knee-jerk. Moreover, by his mental reaction, the patient did 
his best to conform to the dementia syndrome which his inter- 
locutors had in mind. But when a precise and rigorous method 
of examination had been pursued without parti pris, a very dif- 
ferent picture presented itself, that of deliberate simulation in an 
ignorant person of low intelligence. 

Many alienists have stated that a simulator is of necessity ab- 
normal. While in the strict sense this is true, yet in some cases 
it is only so on account of a faulty environment having determined 
anti-social reactions in a person in himself quite capable of normal 
social reactions had the environment been healthy. The trouble 
is sociological rather than medical. 

On the other hand, simulation is often performed through imi- 
tation, which is a form of suggestion. The best example of this 
is the psychic contagia so frequently seen in hospitals among the 
attendants and patients when these are of inferior intellectual 
grade. The hysterical crises of Charcot's day were a striking 
example. Now-a-days, a case of appendicitis in a woman's college 
will bring twenty girls to the doctor complaining of symptoms 
which they imitate according to fancy. I need not here insist 
upon the psychology of imitation, upon which these phenomena 
depend. They are inextricably intermingled with those of sug- 
gestion. 



I9IO] TOM A. WILLIAMS 293 

Again, consciousness is a matter of degree ; and a person who 
imitates or is suggested into a symptom without knowing how or 
why may conveniently be called a hysteric : he is not clearly con- 
scious of the process by which he believes. The simulator, on the 
other hand, imitates his symptom deliberately and with intent to 
deceive. The line is not easy to draw ; for each consciously or 
unconsciously grasps at every straw by the way in order to fortify 
and make to prevail his mental pose. Both states are favored by 
the same mental make-up. Its tendency is towards impression- 
ability without complex co-ordination, and to facility of judgment 
without reflection. The state is commonest during the pubescence 
of young girls, and is conduced to by faulty education in con- 
junction with the tremendous demands for psychic readjustments 
at puberty. 

The Diagnosis of Simulation, 
neurological signs. 

The difference between the deliberate simulator who wishes to 
gain an end and the real hysterical is that the latter cannot be 
tripped up in the way in which this patient was trapped. When 
by psychotherapy, a hysterical anaesthesia is made to disappear, 
the patient continues to feel for some time at least, i. e., until the 
suggestion which has caused the anaesthesia regains the ascend- 
ency. Our malingerer on the contrary showed that he felt only 
when he was surprised into doing so, and never expressly. A 
true hysterical is, as a rule, unsuspicious ; for he is so dominated 
by his induced-idea, in which indeed he believes firmly, that he 
has no cause for alarm. 

I do not intend to discuss our patient's simulation of dementia 
and amnesia. The means for unmasking this very common at- 
tempt are well known ; they need not be insisted upon, as they are 
brought out, although shortly, in the history. 

Simulators often pretend motor disability. If it is hemiplegia, 
the subject does not, as a rule, swing the leg as does a truly para- 
lyzed man. 

Again, when arising from a lying position, the simulator uses 
both haunches, which a man who has a completely paralyzed leg 
is unable to do. 



294 THE SIMULATION OF HYSTERIA [Oct. 

If the arm is alleged to be affected, one will always be able to 
detect different inequalities in the grasp as measured by the 
dynamometer at different times. This is most clearly shown when 
the simulator's attention is distracted while he squeezes the 
instrument. 

If the arm is contractured, to and fro passive movements would 
generally reveal anomalous muscular contractions especially while 
the patient's attention is diverted from what one is doing. 

A completely paraplegic man, even though he may sit propped 
in a chair, is incapable of moving himself onto another one : a 
simulator who does not know this can be unmasked. 

In a simulated paralysis, there is no diminution or increase of 
tonus. This can be shown by the fact that there is no depression 
of the affected shoulder or falling of the hand or foot when at 
rest ; and the examiner cannot overflex the forearm or hyper- 
extend the knee. 

The " hand-falling sign " of Ramist " is ascertained by gently 
maintaining the patient's hand and forearm in a vertical position 
while his elbow is rested upon a table, bed or the arm of a chair, 
and while distracting his attention, quietly letting go the hand. 
If there is an organic paralysis, the hand will fall ; if not, it re- 
mains extended for a considerable period. 

Contractures. — Severe hemiplegia with contracture is always 
accompanied by associated movements. There are no such move- 
ments in psychic or simulated paralyses. When an effort is made 
to move the paralyzed limb, the movements which occur on the 
other side of the body are always the same in the same case ; and 
they correspond to the strongest normal movement of the limb. 
In the arm, it is flexion towards the mouth ; in the lower limb, it 
is extension, accompanied by elevation of the heel. An import- 
ant fact is that organic contracture is never complete, is most 
severe distally, and is usually in the antagonists of the strongest 
muscles. 

The Walk. — In walking sideways, a paralyzed patient only 
drags the foot on the floor when walking towards the sound side ; 
simulators usually will drag the foot along the floor in walking 
towards the side they believe unsound. 

I need not insist upon the now well known dorsi-flexion of the 
toe which characterizes organic affections of the cortic-spinal 



igio] TOM A. WILLIAMS 295 

path ; nor need I discuss the combined flexion sign, which we also 
owe to Babinski ; and I need only mention the sign described by 
Hoover, and its modification of Zenner, which depends upon the 
synergic downward pressure of one lower limb when a patient 
attempts to raise its fellow while both are extended upon the bed. 
They are all now elementary neurological tests. 

Sensory Symptoms. — To detect the simulation of a hyperses- 
thetic area, the examiner may press at the same time with two 
fingers, one on the painful spot and the other close by, so as to 
cause both impressions to be felt as one. Pressure on the alleged 
hyperaesthetic area is then to be gradually ceased. A simulator 
will continue to complain of pain. Of course a really painful spot 
will cause a more rapid pulse when it is pressed upon, and may 
also produce homolateral dilatation of the pupil. But these signs 
are both inconstant and difficult to estimate even with the aid of 
the sphygnamomanometer, which may, however, show an altera- 
tion of the plateau and a dicrotism. 

It is very difficult to unmask simulated deafness ; but simulated 
blindness is often revealed by an affection of clumsiness in button- 
ing the coat, touching the fingers together, striking a match, etc. 
A really blind man is quite adroit in any of these manoeuvres. 
A hysterical patient with contracted visual fields does not fall 
over objects placed to either side, a simulator does so. Hart- 
ridge's ^ modification of the Flees' box is very convenient in un- 
masking simulated amaurosis of the eye. 

The patient who simulates aphonia will pretend that he cannot 
whistle, which a hysterical generally does quite freely. 

The simulation of hysterical convulsions may be taken for 
epilepsy, which itself is well known to be often simulated. In the 
true epileptic fit, the pupils are, however, paralyzed or at least 
sluggish ; and blood and urinary changes, chemical or physical, 
should render the diagnosis not difficult. 

Flora" has alleged that the muscles that are weakened in the 
course of a traumatic neurosis " nearly " failed to respond by 
tetanos to long faradic stimulation. His assertions have not been 
confirmed ; and I have no experience of the test. The same may 
be said of Lombroso's allegation that the temperature is one degree 
lower on the diseased side. 

In conclusion, I need only emphasize the importance of a knowl- 



296 THE SIMULATION OF HYSTERIA [Oct. 

edge of, and capacity to use at the bed side, neurological signs, 
which, in conjunction with clear conceptions of the natural history 
of nervous disease are the only means by which the physician can 
hope to diagnose the simulation of hysteria. 

REFERENCES. 

1. Author : The Trend of the Clinicians Concept of Hysteria. Boston 

Med. Jour., 1909, March 25. 

2. Le Definition dc I'Hysterie. Rev. Neurol., 1901. 

3. Discussion sur I'Hysterie. Soc. de Neurol, de Paris, 1907. 

Also see Author's Status of Hysteria, New York Med. Jour , 1909 ; 

Jan. 9. 

4. Author : The Nature of Hysteria. International Clinics, Autumn, 1908. 

5. Babinski : Ma Conception de I'Hysterie. Paris, 1906. 

See also Trans, by Chaddock Interstate Med. Jour., 1908. 

6. See Report in Revue Neurologique, 1907. 

7. Author: The differential Diagnosis of Neurasthenia from Conditions 

for which it is Often Mistaken. Arod. of Diag., Jan., 1908. 
Also The Positive Diag. of Hysteria and Psychasthenia. New 

Orleans Med. Jour., May, 1909, etc. 
Also Genesis of Hysterical Symptoms and their Relation to Fears 

and Obsessions in Childhood. Med. Record, Aug. 6, 1910. 

8. Revue Neurologique, Dec, 1909; Jan., 1910. 

9. Author: The Relative Value of the Affective and Intellectual Pro- 

cesses in Inducing Traumatic Neurosis. Jour. Abnor. Psychol., 
1910. 
See also an article in Med. Record, Oct. g, 1909. 

10. See Discussion sur I'Hysterie, Loc cit. 

11. Janet employs this criterion in his works Automatisme Psychologique, 

1889. Nevroses et Idees Fixes, 1897, and The Major Symptoms of 
Hysteria, 1908. 

12. Freud : Explains Psychoneuroses as the result of the Intrusion of un- 

pleasant ideas driven out of consciousness by the Patient. These 
act as foreign bodies, and attract other thoughts, as bacteria do leu- 
cocytes. 

See Sammlung kleiner Schriften zur Neuroscnlehre, 1906. 

Also Selected papers on Hysteria. Trans, by Brill, New York, 1909. 

13. Freud : Applies this word to his method of cure by Psycho-analysis. 

It depends upon the principle that submerged ideas lose their un- 
pleasantness and cease to cause distress as soon as they are freely 
expressed. 

See also Jung. Zur der Psychologic oder Dementia Prcecox, also 
Translated in Nervous and Mental Monographs, New York, 1908. 

See also Psychotherapeutics, A Symposium, Jour, of Abnormal 
Psychol., July, 1909, for a clear and short account of the principles. 



igiO] TOM A. WILLIAMS 297 

14. Author : The Importance of Modifications of the Sensibility in the 

Diagnosis of Disease. Amer. Jour. Med. Sci., April, 1909. 

15. Toulouse, Pieron et Vaschide: Examen des Sujets. Paris, 1901. 

16. Dejerine: Semiologie des Maladies du Systeme Nerveux. Traite de 

Med. de Bouchard-Brissaud, 1900. 

17. Le Demembreinent de I'Hysterie, Semaine Med., Jan., 1909. 

18. Un Cos d' Autosuggestion Scientifigue, Revue de I'Hypnotisme, 

1903- 

19. La Localizzazoni Cerebrali in un Caso d'Ipnotism. Foligno, 

1891, Vol. I. 

20. Une Nouvclle signe d'Hemiplegie Organique. Revue Neu- 

rologique, 1909, Nov. 30. 

21. The Diaphragm Test for Binocular Vision. Brit. Med. Jour., 

Oct., 1909. 

22. Clinica Moderna, XI, Nos. 10, 11. 



METABOLISM IN DEMENTIA PRECOX. 

By GIACOMO PIGHINI and GIUSEPPE STATUTI. 

(From the Scientific Laboratories of the Institute of Psychiatry. Giacomo 
Pighini, Director. — Reggio Emilia.) 

Third Paper. 

Following the studies upon the metabolism in dementia prsecox,' 
already carried on by one of us, we now publish the results of four 
new cases examined, to which we add, as a comparison, another 
case of manic-depressive insanity. Two of the four cases of 
dementia prsecox studied belong to a phase of acute exacerbation 
of the illness in its chronic phase ; the other two show a dementia 
of long standing. All these patients have been studied very care- 
fully over a long period in the Institute ; so the diagnosis of their 
mental state may be considered quite certain. In this series of 
researches we devoted special attention to the azotic balance, and 
to the proportion between the various forms of sulphur eliminated 
in the urine: — inorganic, ethereal, and neutral sulphur. Re- 
searches were made as follows: The patient was kept in bed 
during all the period of experiment, attended by a special nurse 
and put on a special diet, some days before the collection of the 
feces, that he might reach an equilibrium on the new diet. This 
diet was always made up of cows milk 1000-2000 ccm., fresh eggs 
200-300 g., sugar 50 g., salt 2 g. According to the individual 
weight, the daily quantity of milk and eggs given varied, so as to 
afford every day 25-30 calories 0.20-0.25 g. of A'^ pro Kg of 
weight, a sufficient quantity to keep the equilibrium during the 
continued rest in bed. For each experiment the milk was first 
mixed in a large receptacle, then the daily ration transferred to 

' G. Pighini — II ricambio organico nella demenza precoce. Rivista Speri- 
mentale di Freniatria, XXXII, I-II, 1906. 

Id. — II ricambio organico nella demenza precoce. Nuove ricerche. (N. 
NaCl, C, Ca, P, K, S.) R. Sper. di Freniatria, XXXIII, II-III, 1907. 

Id. — The organic metabolism in dementia praecox (Notes I and II), 
Archives of Neurology and Psychiatry, Vol. IV, 1909. 



300 METABOLISM IN DEMENTIA PRECOX [Oct. 

large Erlenmeyer flasks was sterilized. With a small portion of 
this milk a N and P determination was made. Four or six eggs 
were used, the weight of the shells being deducted. From the 
different determinations made of A'^ and P content of the whites 
and yolks, and calculating 3 : 2 the proportion of the two sub- 
stances, we came to the following averages which we followed in 
calculating the amount of these two elements in the diet used: 
iV = 2.087 per cent ; P = 0.2799 per cent. Then we could calculate 
every day with sufficient exactness how much nitrogen and phos- 
phorus was introduced with the food. The urine was collected 
with care and examined every morning. 

Limiting the beginning and the end of the experiment with a 
high clyster of 1500 ccm. of distilled water, feces were col- 
lected, broken up in water and slowly evaporated at 100° C, dried 
in an oven, pulverized and weighed for A'" and P determinations. 
The methods used were as follows : Kjeldahl for A'; for P and 
total sulphur, incinerating and fusing with nitrate of potash and 
carbonate of soda, and weighing the pyrophosphate and the bi- 
sulphate. According to known processes : the ureometer of 
Hufner for the urea ; the inorganic and ethereal sulphuric acid 
according to Salkowski ; total sulphur according to Schultz. 
Often the research was carried on with two methods at the same 
time as a control. 

It was our intention to make a comparison between the metab- 
olism of many cases belonging to several mental disease groups 
in definite clinical phases, but our work was interrupted. We 
publish at present these few cases, which are interesting in that 
they confirm in a great part the former studies made in our 
laboratory, and they tend to stimulate this method of research, 
which is by many considered false and without result. Among 
the five cases examined, the manic-depressive one gave results 
that may be considered relatively normal. They agree with the 
commonly accepted figures concerning excreted metabolic sub- 
stances, and there is found a perfect balance of nitrogen and 
phosphorus ; and while they show us, on the one hand, that in the 
acute phase of this disease, in all probability there are no altera- 
tions of metabolism ; on the other hand, they give us valuable 
data for comparison with other results obtained under the same 
conditions of experiment and with the same diet. 



igiO] GIACOMO PIGHINI AND GIUSEPPE STATUTI 30I 

We will present, first of all, this case of manic-depressive in- 
sanity with which we shall compare the results of the following 
four cases of dementia precox: 

Case No. i.— Malag. Giosue (Table i). Male, age 38, by trade a hand- 
craftsman. He has been always a hard-working man, of a mild character 
and a rather acute intelligence. He never drank to excess and was a 
moderate smoker. Five years ago he was troubled with general weakness, 
a stubborn indisposition, a psychical depression that progressively accentu- 
ated into symptoms of profound melancholy. Also, there were anxiety, 
tachycardia, a sense of ruin, and of a near death. He was brought into 
the asylum, where he was put on general treatment, and in a few months 
he had recovered. In April, ipog, his trouble began again with the same 
symptoms : physical and psychical depression ; profound melancholy, for 
which he himself could not find the reason ; a sense of oppression over the 
chest and an incapacity for attending to any work. His ideas, though they 
answered to the coenesthesis and to depressed feelings, are clear and well 
ordered. A week after his entering, when he began to get better, the patient 
was started on the metabolism examination, to which he willingly con- 
sented. Physically, nothing abnormal was made out. The pulse was 
strong, between 60-90 per minute, the temperature between 36°-36.S° C. 
A month after, the patient recovered, left the asylum; but after some 
months, during which he was entirely well, had another relapse, and was 
re-admitted again, the 23d of October last. Then, the symptoms were 
typical of manic-depressive insanity. During the period of experiment, 
from the 8th to the 17th of April, the patient consumed every day 1500 to 
2000 ccm. of milk and 6 eggs. In the milk was found : N = 5.392% ; P = 
0.52%. Total weight of feces dried was 330 gm. 

It is seen in Table I that the balance of nitrogen and phosphorus 
may be considered in equilibrium ; that urea and urea nitrogen 
represent normal quantities, comparing it with the medium figures 
obtained by Schultz and by Gumlich with an animal diet (87-89 
per cent of N urea). The ethereal sulphur and neutral sulphur 
stand in normal relation to the total sulphur. The average daily 
amount of ethereal sulphuric acid (0.09 gm.) is within the normal 
limits according to Noorden and Biernatzki, neutral sulphur 
representing 19.96 per cent of the total 5" shows medium values. 
The amounts of nitrogen and phosphorus eliminated in the feces 
are tnaintained within the physiological limits. We can consider 
the metabolism of these ten days as normal. We cannot say the 
same of the metabolism of the four cases of dementia precox 
which we have to describe. The first two cases represent a period 
of stasis of the disease in a much advanced phase ; the last two 
show acute symptoms of the disease in the initial phase. 



302 METABOLISM IN DEMENTIA PRECOX [Oct. 

Case No. 2. — Sol. Ermelia Linda (Table II), female, age 25. She is 
pale, anemic, undernourished; was received in the asylum two years ago. 
The mental symptoms appeared slowly with a change in character and 
habits, ideas of persecution, and suicidal tendencies. The condition gradu- 
ally became worse. She has had at intervals periods of light sensorial 
excitement, during which it was necessary to resort to artificial feeding. 
At the present time she is quiet and apathetic; does not respond to any 
stimulus, and is profoundly deteriorated. She presents symptoms of a 
slight bronchitis, but no sputum could be obtained to determine the nature 
of this trouble. 

On the 13th of February, 1909, the experiment, to which she willingly 
assented, was begun. From the i6th to the 25th the feces and urine were 
carefully collected. During all this period the patient remained quietly in 
bed. Her temperature was normal, and the pulse, though rather weak 
and frequent, was regular. About a month after the experiment, bron- 
chial symptoms became more evident at the apex, and the bacillus of Koch 
w'as demonstrated in the sputum. At the same time the general conditions 
grew rapidly worse, and symptoms of subacute tubercular peritonitis w'ere 
manifest. The 17th of November, 1909, the patient died in a marasmic 
state; and at the autopsy were found some tubercular lesions in the lungs 
and peritoneum. The pial meninges were slightly opaque, the cerebral 
hemisphere anemic without evident macroscopic alterations. During the 
experiment the patient took on an average 1500 ccm. of milk and 4 eggs. 
The milk given contained : N = 5.402% ; P = 0.430%. Total weight of 
dried feces was 195 gm. 

Case No. 3. — Rom, Marianna, female, age 20 (Table III). A brother, 
a case of dementia priecox, recovered in this asylum. The patient, a 
servant, was intelligent and industrious, until about a year ago. In August 
last she did her work reluctantly. Sleep was poor. She was mute at times 
and again often excited in response to ideas of persecution and hallucina- 
tions. She was dismissed from her position and returned to her family 
where she became worse and continued in a state of anxiety and fear. 
Oftentimes she was controlled by hallucinations. She was extremely 
erotic. She was sent to the asylum because of her suicidal tendencies. 
When she was admitted, she was a pleasing, rosy, well-nourished girl. 
She showed a profound alteration in her imagination and in her mien ; she 
insisted on believing she had come to the hospital as a nurse; she mimicked 
the habits of one, took her keys and tried on all occasions to assume the 
functions of the nurse. Her physical condition gradually became less 
favorable and she took the nourishment poorly. The mental functions 
grew steadily more feeble. In the month of May, during which this study 
was carried on, she was rather careless in habit and quite disturbed men- 
tally. Mannerisms were present, and negativism was noted. Because of 
resistance by the patient, this experiment was not completed. Thus, only 
in the six days from the i8th to the 23d was it possible to collect completely 
the feces and urine, and to get her to take all of the food : our experiment 



I9IO] 



GIACOMO PIGHINI AND GIUSEPPE STATUTI 



303 



then ought to be hmited to the consideration of only 6 days. At the 
present time, January, 1910, the patient is in the same physical condition, 
but in a more advanced state of dementia. During the experiment, she 
took one litre of milk and six eggs a day. In the milk there was N = 
5.381%; P = 0.420%. Dried feces of the six days weighed 71 gm. 

Case No. 4. — Ross, Alfredo (Table IV), male, age 29. A sister is an 
hysteric of long duration. The patient was a clerk in an apothecary shop 
until a short time ago, and showed a normal assiduity and intelligence. In 
the last months of 1908, his character gradually changed. He became 
irritable, showed less inclination to work, and was dismissed. During this 
unoccupied period he became quiet and taciturn ; with periods of psycho- 
motor excitation were alternated phases of mutism. Having shown sui- 
cidal tendencies, he was admitted to the asylum on the 17th of February, 
1909. He is a beardless young man, of a delicate constitution, rather pale, 
and having a negativistic mien. Being asked over again his name, he 
answers: " Bardolin." His ideas are confused, he expressed himself 
vaguely, and with invented words. On the 20th, rather suddenly, he began 
to strike his head against the wall, evidently with suicidal intent, and 
shortly after he fell into a catatonic and stuporous state. He was put to 
bed, where, during ten days, he continued agitated, rigid, very confused 
and stuporous. In moments of great psycho-sensory agitation he saw the 
room populated by strange and terrible beings, and called to them aloud, 
carrying on an unintelligible conversation with them. On physical exami- 
nation nothing noteworthy was met with ; lungs, kidneys and intestines 
functioned regularly. His temperature was elevated during the first five 
days of the acute poussee, then it returned to the normal. When he had 
become more quiet and tractable, although continuing to show the hallu- 
cinatory symptoms and the subcatatony, the experiment was begun. The 
ist of March, he began the diet, and from the 3d the urine and feces were 
carefully collected. During ten days the condition of the patient was 
stationary, but at the last a little improvement was noted in his appear- 
ance, and a greater orientation of his ideas was evident. The temperature, 
pulse and change in weight, during the acute period, beginning February 
20 are here given : 

Weight 

Kg. 
55.200 



February 20 37.3 



March 



21 
22 
23 
24 

25 
26 

27 

28 

I 

2 



orning 


Evening 


°C. 


°C. 


37-3 


37.8^ 




37-3 


37-5 




37-2 


37.4 




37.8 


37-5 




36.8 


371 




39-9 


36.7 


-Pulse 90-103 


36.9 


38.4 




36.1 


36.4 




36.1 


36.5 




364 


37 




36.3 


36.6J 





304 



METABOLISM IN DEMENTIA PRECOX 



[Oct. 



March 



3 
4 
5 
6 

7 
8 

9 
II 

12 

13 
H 



Morning 
°C. 

.. 367 

.. 36.4 

•■ 36.9 

•■ 36.3 

.. 36.1 

. . 36.2 

.. 36.4 

. . 36.4 

.. 36.3 

■• 36.4 

•■ 36.S 



Evening 

3(^7 ^ 

36.5 

37 

36.7 

36.5 

36.5 

36.4 

36.S 

36.8 

36.6 

36.S. 



Weight 
Kg. 

54.000 



-Pulse 80-95 



53.200 



After the experiment the patient continued to get better ; he became 
calmer and more orderly in his manner, and no longer showed evidence of 
hallucinations and acute exacerbations. Intelligence, after the crisis, was 
rather diminished, and so it is at the present time after almost a year of 
illness. Now, the patient is apathetic, shows no affection for his family, 
and is without aspirations. He has abandoned his profession, and occa- 
sionally shows some idea of persecution, and is very changeable in emo- 
tional tone — some days meek and gay, intractable and gloomy others. 

During the ten days of experiment he took nearly 1250 ccm. of milk and 
4 eggs a day. In the milk there was AT = 5.39% ; P =: 0.423%. Weight 
of all the feces dried, 117 gm. 

Case No. 5. — Paterl, Irmo (Table V), male, age 22. He presents a 
serious psychophatic inheritance. Two years ago, having entered the 
asylum during an acute phase of dementia praecox, he was subjected to 
some researches of metabolism. After having shown symptoms of acute 
sensorial delirium, paresthesias, negativism, dermographia, hyperthermia, 
etc., he gradually deteriorated and demented.^ A year afterwards his ap- 
pearance was more orderly, but deterioration was marked. As his family 
required him, he was discharged. But, some months after, he again showed 
acute symptoms of motor agitation accompanied by hallucinations and 
suicidal tendencies, and he was again received at the asylum. He entered 
the 3d of January, and appeared very confused, in a state of hallucinatory 
stupor in which he remained nearly a week. Gradually, he became calm, 
and was quiet during the three months, showing still a very tardy percep- 
tion — every affection and sentiment perfectly extinguished. At the end of 
April, he developed another acute phase of motor agitation, accompanied 
by hallucinatory delirium, stupor and sitophobia. He was nourished arti- 
ficially and kept in bed. His temperature varied between 37-38° C, 37.5° C, 
never attaining 38°. These symptoms were already improving and the 
patient began to take food voluntarily, when, on May 3, the study of 

'The organic metabolism in dementia praecox, Note II, Observ. I, Ar- 
chives of Neurology and Psychiatry, Vol. IV, 1909. 



igio] 



GIACOMO PIGHINI AND GIUSEPPE STATUTI 



305 



metabolism was begun. During ten days, from the 5th to the 14th, feces 
and urine were collected uninterruptedly, and through all this period the 
patient steadily improved. During the first five days (Sth to Qth) he was 
more agitated, and on this account in Table V we have separated the 
analytical results of these days from those following, during which he was 
quiet. 

At the end of the experiment, the patient left his bed, and began to lead 
the ward life with his comrades, resuming his usual attitude of half stupor 
and of intellectual torpor. As his relatives wished to have him home, he 
was dismissed again, and now is cared for at home. Subsequent informa- 
tion shows that he remains at home quietly, but is confused and needs 
constant attention. During the experiment the temperature was always 
normal. 

FIRST PERIOD. 

May 5 Morning, 36.4 Evening, 36.9 

" 6 " 35-9 " 36.4 

" 7 " 36.6 " 36.5 

" 8 " 36.6 " 36.S 

" 9 " 36.5 " 36.6 

SECOND PERIOD. 

May 10 Morning, 35.8 Evening, 36.4 

"II " 36 " 36.7 

" 12 " 36.1 " 36.4 

" 13 " 3S-9 " 36.4 

" 14 " 36 " 36.2 

Milk composition, as in Case 3. 





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i9io] giacomo pighini and giuseppe statuti 3ii 

Summary and Discussion of Results. 

I. Dementia prsecox in chronic phase: In the first two cases 
of dementia prsecox — (Nos. 2-3, Tables II-III), belonging to a 
phase well advanced dementia, we meet the greater number of 
concordant data, only those relating to the metabolism of sulphur 
being at variance. We shall see the most probable cause of this 
difference : 

Nitrogen.— Above all, it is to be noted that the balance of the 
nitrogen is not in equilibrium ; a retention of nitrogen is noticeable 
in both cases, or, at least, an elimination in urine and feces less 
than the intake. In Case No. 2, there is a retention of 1.041 g. 
pro die, on an average; in Case No. 3 of 0.385 g. At the same 
time, however, an increase of weight was not found in the two 
patients — and Case No. 2 in the first ten days lost 500 g. Urea 
was eliminated in absolute and relative quantities that were about 
normal (88.9%-90.8% of urea). 

Phosphorus : — The percentage of phosphorus is well in accord 
with that of the nitrogen ; therefore, a retention is noted also here, 
though less marked. This is made evident by the N/P ratios of 
the urine, which are nearly normal — 9.7-10.7, and by the relative 
amounts of these two elements in the food compared with the total 
■quantity eliminated in the urine and feces. In fact, we have : 

In Case No. 2: N/P of food =10. 

AVF total eliminated 10.5. 

In Case No. 3 : N/P in the food 10.5. 

N/P total eliminated 10.5. 

Sulphur. — A marked difference is noted in the two cases. 
While in Case No. 3 the ratio N/S may be considered a normal 
one, as also the elimination of conjugated sulphuric acid and of 
neutral sulphur, in Case No. 2 we have an exaggerated elimina- 
tion of 6" relatively to N (12.0%), and accentuated production of 
ethereal sulphur, and a very accentuated increase of neutral 
sulphur — 46%. 

In this last report, we were really surprised, and remained a 
little perplexed, because it was contrary to results which we had 
found in all former work in our laboratory respecting sulphur 
balance in advanced and chronic states of dementia prsecox. In 
fact, an exaggerated increase of neutral sulphur in the urine, we 



312 METABOLISM IN DEMENTIA PRECOX [Oct. 

only observed in acute and initial periods of disease. Thus, it 
was a matter of great satisfaction for us to be able to find the 
reason of this unusual variation, when after about a month we 
perceived in the patient the certain signs of a pulmonary tuber- 
culosis, which infection proved fatal, and the diagnosis was veri- 
fied at the autopsy. 

Pulmonary tuberculosis, in fact, especially at the beginning, is 
enough in itself to cause the exaggerated elimination of neutral 
sulphur in the urine, and to increase the A'^ ration. These two 
facts have been noted earlier by Reale and Velardi," who found in 
incipient pulmonary tuberculosis an increase in total 5" in the urine 
with a percentage of 42.29 of neutral 5 ; and in advanced pulmo- 
nary tuberculosis 46% of neutral S. In our case we find 46.7% 
and a ratio A''/.S" of 12.9. This is a great deal higher than the 
normal, which may be obtained with our diet, i. e., about 7. In 
Case No. 2 then, we believe we may attribute this variation in 
sulphur excretion as due to the phthisis and not to the psychosis. 

2. Dementia prsecox in an acute phase. Nitrogen. In the .two 
other cases of dementia prsecox (Nos. 4 and 5 — Tables IV, V) 
studied during an acute exacerbation of the disease, when this may 
be considered as an initial state, we find a very different type of 
metabolism ; while in the first two cases we find retention ( ?) of 
nitrogen, we find here an excessive elimination. There occurred a 
very considerable daily loss of nitrogen in Case No. 4, 3.657 gm. 
pro die, a marked loss the first period in Case No. 5, 1.573 g'^i''- 
pro die, less marked in the second, 0.89 gm. Urea in both cases 
was eliminated in a considerable quantity for the diet, but in a just 
proportion to the total nitrogen of urine : urea nitrogen, in fact, is 
represented by the normal figure, 91.6, 88.9, 89.2. 

Phosphorus. — The balance of phosphorus is also decreased, but 
in a lesser degree than the nitrogen. In Case No. 4 we find a 
daily loss of 0.098 gm. ; in No. 5, ist period of 0.194 gm., 2nd 
period 0.076. This loss, however, does not remain quite propor- 
tional to the nitrogen one, the A'^ of urine being a little lower than 
the P in reference to the normal ratios. Case 5 is an exception : 

'Reale e Velardi — Sull' eliminazione dello solfo neutro per le orine, ref. 
Boas Arch. 2-141, 1896. 
E. Reale — Manuale de chimica clinica, 1907, p. 442. 



I9IO] GIACOMO PIGHINI AND GIUSEPPE STATUTI 3I3 

1st period in which P is 10.53% oi N. That the N/P ratio is 
not within normal Hmits is seen where we compare these ratios 
as found in the initial outgo. The following figures are found : 
No. 4 — Food N/P =10.2 
Urine and feces N/P= 8.3 

No. 5 — Food N/P =g.g 

,_ fist period 10 



Urine and feces N/P — -, . ■ , o 
1 2nd period 8.7 

Phosphorus in the feces is very low in amount, especially in Case 

No. 5. 

Sulphur. — The balance of the sulphur metabolism affords a most 
interesting element of study in these cases. No disease other 
than this mental alteration being demonstrated in these patients, 
the anomalies of sulphur metabolism may be attributed in all 
probability to the mental disease itself. Then, also, it is noted 
that in the most acute phase — that is to say in all ten days of 
Case No. 4, and in the first five days of Case No. 5, there was a 
considerable increase of sulphur in the urine, both absolutely and 
relatively to the total nitrogen. We find for the N/S ratio the 
figures 12.39 ^nd 10.5, while in the second period of Case No. 5 
the same ratio remained within physiological limits (7) ; and, 
■ further, a point which makes our results the more interesting is 
the exaggerated elimination of the non-oxidized sulphur in the 
first two periods. From this it appears evident that the increased 
elimination of sulphur relative to the nitrogen, and of neutral 
sulphur relative to oxidized sulphur characterizes the m.etabolism 
of the most acute periods of our patients. 

In regard to the ethereal sulphates, is only to be noted the 
slight increase observed in Case 4. 

From the observations above given we can draw the conclusion 
that in dementia praecox, both in its acute periods and in its 
chronic phases of dementia, metabolic functions are carried on in 
an abnormal manner. Rather noteworthy and characteristic in 
these two cases is the nitrogen retention, which one of us has 
always noted in the other eight cases of dementia praecox ex- 
amined. 

Can we really speak of retention? This would be a plausible 
explanation if in our patients and in those in whom the same 



314 METABOLISM IN DEMENTIA PRECOX [Oct. 

phenomena have been observed, there was an increase in weight 
coincidently ; but this has not been the case. The explanation of 
the fact remains still uncertain. In the two acute cases which 
we here present, we see the same alterations which have been ob- 
served in the other four cases studied previously : that is to say — 
an excessive elimination of nitrogen, phosphorus and sulphur, and 
an excessive percentage of neutral sulphur; coincidently there 
was always observed in these patients a diminution of the body 
weight. To these alterations of the metabolism in the acute phase 
of illness, we believe we may give a certain importance, and do 
not consider them as casual results, or as only variations inde- 
pendent of the mental disease. As in these patients the mental 
disorder is unaccompanied by evidences of other physical disease, 
the metabolic alterations as found in these studies must be looked 
upon as due to the mental disease itself. These alterations seem 
to characterize this special period of the disease. We believe that 
we may take into a certain consideration now the type of balance 
that we have constantly observed in six cases of dementia prascox 
during a period of acute exacerbation of the illness in connection 
with the excessive elimination of nitrogen, phosphorus and sul- 
phur, and particularly the increased relative amounts of the unoxi- 
dized form. These observations taken together intimate the ex- 
istence of a protein katabolism in the organism during the period 
in question, and the constant loss of weight sustained that hypo- 
thesis ; while on the other hand the increase of the unoxidized 
sulphur must indicate a want in the oxidative process or an in- 
tense poisoning of the organism. Human and experimental 
pathology has long since demonstrated a direct relation between 
the abnormal elimination of neutral sulphur and the process of 
intoxication or of deficient cellular oxidation. Thus, we know of 
the high percentages of neutral sulphur, which are found in 
diabetes (Reale and Velardi), in pernicious anemia (R. Schmidt), 
in the anemia of anchylostomiasis (Schupfer a De Rossi), in fast- 
ing, (F. Mueller, Harnack and Kleine, Freund), in experimental 
poisoning by phosphorus, (Kast a Miinzer), cyanide, (R. G. Wal- 
lace), chloroform (Savelieflf, Rudenko, Benedikt), and chloral 
(Harnack and Remertz) ; in the experimental autopoisoning by 
thyroidectomy (Ducceschi), etc. We do not know really to which 
poison to attribute the phenomena of protein katabolism, and of 



igiO] GIACOMO PIGHINI AND GIUSEPPE STATUTI 315 

exaggerated neutral sulphur found in our experiments ; nor to 
which textures of the body belonged the N, P and S excessively 
eliminated. We limit ourselves now to verifying the fact, and to 
point out the necessity of continuing in this kind of research, in 
order to clear up some points in the etiology of this disease. 
From what we have explained, it seems that we do not take part 
in the skepticism of Folin and Barnes, concerning the results that 
may be derived from researches in the metabolism of mental 
disease, in general, and dementia prsecox in particular. Folin,* 
in the long series of accurate observations that he has made, 
arrived at the conclusion that, excepting perhaps the cases of pro- 
gressive paralysis, wherein some disorder of metabolism is often 
noted, although sometimes variations from the normal are found, 
these are not characteristic of any one psychoses or group. Yet, 
it is still to be noted, we may still observe that, in so far as 
dementia pr?ecox is concerned, Folin kept no account of the clin- 
ical stages of the illness, but examined some patients in the acute 
initial phase of the disease, when alterations are more often 
found. Not having calculated minutely the balance of nitrogen 
and phosphorus, Folin cannot give an accurate value to the de- 
ficient elimination in the urine and feces of these two elements, 
which we have found disturbed in the advanced phases of the 
disease. Also, Barnes,' in a recent study of the metabolism in 
two cases of dementia prascox, presenting acute phases alternating 
with phases of relative tranquillity, arrives at the conclusion that 
with the methods used one cannot decide whether or not, in the 
cases in question, there exists phenomena of auto-intoxication. 
But, not having exactly calculated the quantity of introduced 
nitrogen, one cannot value the balance of nitrogen. In Case I, 
followed more completely, there were periods of exaggerated 
elimination of A'^ (i3-5 gm.) in the urine, on an average, pro die 
in a period of fasting, i8 gm. In the 2nd period with nourishment 
of eggs and milk, also the ratio S/N is found increased, and the 
quantity of neutral sulphur eliminated very exaggerated in certain 

' Folin and Ph. Shaffer — Some metabolism studies, with special refer- 
ence to mental disorders. American Journal of Insanity, LX-LXI, 1907. 

° Barnes — A study of the metabolism of two atypical cases related to the 
dementia praecox group. The American Journal of Insanity, LXV, No. 4, 
1909. 



3l6 METABOLISM IN DEMENTIA PRECOX [Oct. 

periods (3rd period on the starch and cream diet, 40.06%, on an 
average pro die). From this study of Barnes then should result 
data which quite accord with ours. 

We do not presume, at any rate, to give from our researches 
any definite conclusion ; we wish to continue further the series of 
our observations, and to extend our study to include other impor- 
tant constituents of the urine of the undetermined N, to which 
Folin has justly directed attention in many of his cases. 



A STUDY OF ASSOCIATION IN INSANITY. 

By grace HELEN KENT, A. M., and A. J. ROSANOFF, M. D., 
Kings Park State Hospital, N. Y. 

PART II. ASSOCIATION IN INSANE SUBJECTS. 
§ I. General Survey of Pathological Material. 

The pathological material which forms the basis of the present 
part of our study consists mainly of two hundred and forty-seven 
test records obtained for the most part from patients at the Kings 
Park State Hospital. 

The different groups from which the cases were selected, to- 
gether with the number from each group, are shown in Table I. 

TABLE I. 

Dementia praecox 108 cases. 

Pariinoic conditions 33 '* 

Epilepsy 24 " 

General paresis 32 •* 

Manic-depressive insanity 32 " 

Involutional melancholia 8 " 

Alcoholic psychoses 6 ** 

Senile dementia 4 ** 

A comparison of our pathological with our normal material en 
masse reveals in the former evidence of a weakening of the 
normal tendency to respond by common reactions. This is shown 
in Table II. 

TABLE u. 

Common Doubtful Individual 

reactions. reactions. reactions. 

1,000 normal subjects 91.7% 1.6% 6.8% 

247 insane subjects 70.7% 2.6% 26.8% 

It seems evident from this that pathological significance attaches 
mainly to individual reactions, so that our study resolves itself 
largely into (i) an analysis and classification of individual reac- 
tions and (2) an attempt to determine what relationship, if any, 
exists between the different types of reactions and the different 
clinical forms of mental disease. 



3l8 A STUDY OF ASSOCIATION IN INSANITY [Oct. 

§ 2. Classification of Reactions. 

Those who have attempted to use the association test in the 
study of insanity have felt the need of a practical classification 
of reactions, and have at the same time encountered the difficulty 
of establishing definite criteria for distinguishing the different 
groups from one another. It is a comparatively simple matter to 
make these distinctions in a general way and even to formulate 
a more or less comprehensive theoretical classification, but there 
still remains much difficulty in practice. We have made repeated 
attempts to utilize various systems of classification which involve' 
free play of personal equation in their application. Although for 
us the matter is greatly simplified by the elimination of all the 
common reactions with the aid of the frequency tables, we have 
nevertheless met with no success. The distinctions made by either 
of us have on no occasion fully satisfied, at the second reading, 
either the one who made them or the other, while a comparison of 
the distinctions made by each of us independently has shown a 
disagreement to the exteat of 20 — 35 per cent. 

We sought, therefore, to formulate a classification in which 
the various groups should be so defined as to obviate the interfer- 
ence of personal equation in the work of applying it, hoping thus 
to achieve greater accuracy. In this we can lay claim to only 
partial success ; for, in the first place, having satisfactorily defined 
a number of groups, we found it necessary in the end to provide 
a special group for unclassified reactions, into which falls more 
than one-third of the total number of individual reactions ; and, 
in the second place, in at least two of our groups the play of per- 
sonal equation has not been entirely eliminated, so that there is 
still a possibility of error to the extent of five per cent of individ- 
ual reactions, which means approximately one per cent of the 
total number of reactions. We have found, however, that in spite 
of these shortcomings the classification here proposed is more 
serviceable than others which, though more comprehensive, are 
at the same time lacking in definiteness. 

Our classification consists of the following classes, groups and 
subdivisions : 



I9IO] GRACE HELEN KENT AND A. J. ROSANOFF 3I9 

I. Common reactions. 

1. Specific reactions. 

2. Non-specific reactions. 
II. Doubtful reactions. 

III. Individual reactions. 

1. Normal reactions. 

2. Pathological reactions : 

A. Derivatives of stimulus words. 

B. Partial dissociation : 

(a) T^on-specific reactions. "^ 

(b) Sound reactions : 
o. Words. 

/3. Neologisms. 

(c) Word complements. 

(d) Particles of speech. 

C. Complete dissociation : 

(a) Perseveration: 

a. Association to preceding stimulus. 
p. Association to preceding reaction, 
y. Repetition of preceding stimulus. 
S. Repetition of previous stimulus. 

e. Repetition of preceding reaction. 

f. Repetition of previous reaction. 

V. Reaction repeated five times (stereotypy). 

(b) Neologisms without sound relation. 

3. Unclassified. 

§ 3. Non-Specific Reactions ; Doubtful Reactions. 

Non-specific Reactions. — It has already been intimated that 
common reactions are in the vast majority of instances to be re- 
garded as normal. From amongst them, however, a fairly defi- 
nite group can be separated out which seems to possess some 
pathological significance, namely, the group which we have termed 
non-specific. 

In this group are placed words which are so widely applicable 
as to serve as more or less appropriate reactions to almost any of 
our stimulus words. That such reactions are in value inferior to 
the remaining group of common reactions, which we have termed, 
in contradistinction, specific reactions, is perhaps sufficiently 
obvious ; we shall speak later, however, of their occurrence in 
both normal and insane cases. 



320 A STUDY OF ASSOCIATION IN INSANITY [Oct. 

It is not always easy to judge whetlier or not a given reaction 
should be classed as non-specific. A study of our material made 
with special reference to this type of reactions has enabled us to 
select the following list of words, any of which, occurring in 
response to any stimulus word, is classed as a non-specific reac- 
tion: 

article, articles 

bad 

beautiful, beauty 

fine 

good, goodness 

great 

happiness, happy 

large 

man 

necessary, necessity 

nice 

object (noun) 

people 

person 

pleasant, pleasantness, pleasing, pleasure 

pretty 

small 

thinking, thought, thoughts 

unnecessary 

unpleasant 

use, used, useful, usefulness, useless, uselessness, uses, using 

woman 

work 

It should be mentioned that some of these words occur as reac- 
tions to one or several stimulus words with such frequency (citi- 
zen — man, value 27.8 per cent ; health — good, value 9.4 per cent) 
as to acquire in such instances a value as high as that of strictly 
specific reactions. 

Doubtful Reactions have already been defined (p. 40) : any reac- 
tion word which is not found in the table in its identical form, 
but which is a grammatical variant or derivative of a word found 
there, is placed in this group. 



i9io] grace helen kent and a. j. rosanoff 32i 

§4. Individual Reactions; Explanation of Groups and 
Methods of Application. 

Normal Reactions. — Inasmuch as the frequency tables do not 
exhaust all normal possibilities of reaction, a certain number of 
reactions which are essentially normal are to be found among the 
individual reactions. In order to separate these from the patho- 
logical reactions, we have compiled an appendix to the frequency 
tables, consisting mainly of specific definitions of groups of words 
to be included under each stimulus word in our list. This ap- 
pendix will be found at the end of this paper. 

A word of explanation is perhaps due as to the manner in which 
the appendix has been compiled. It was developed in a purely 
empirical way, the basis being such individual reactions, given by 
both normal and insane subjects, as seemed in our judgment to 
be obviously normal. 

It must be acknowledged that the appendix falls short of all that 
might be desired. In the first place, its use involves to some slight 
extent the play of personal equation, and it therefore constitutes 
a source of error ; in the second place, it is in some respects too 
inclusive while in other respects it is not sufficiently so. How- 
ever, the error due to personal equation is slight ; the inclusion 
of certain '' far-fetched " or even frankly pathological reactions 
may be discounted by bearing in mind that the general value of 
this group is not equal to that of the group of comm.on reactions ; 
and the number of strictly normal reactions which are not in- 
cluded is after all small. Our experience has shown us that the 
appendix constitutes an important aid in the analysis of individual 
reactions. 

Pathological Reactions. Derivatives of Stimulus Words. — We 
place here any reaction which is a grammatical variant or deriva- 
tive of a stimulus word. The tendency to give such reactions 
seems to be dependent upon a suspension or inhibition of the 
normal process by which the stimulus word excites the production 
of a new concept, for we have here not a production of a new 
concept but a mere change in the form of the stimulus word. 
As examples of such reactions may be mentioned: eating — eat- 
ables, short — shortness, szveet — sweetened, quiet — quietness. 

Partial Dissociation. — We have employed the term dissociation 
to indicate a rupture of that bond — whatever be its nature — 



\ 



322 A STUDY OF ASSOCIATION IN INSANITY [Oct. 

which may be supposed to exist normally between stimulus and re- 
action and which causes normal persons to respond in the majority 
of instances by common reactions. And we speak of partial dissocia- 
tion where there is still an obvious, though weak and superficial, 
connection. Under this heading we can differentiate four types : 

Non-specific Reactions have already been defined ; we distinguish 
those in this class from those in the class of common reactions by 
means of the frequency tables. 

Sound Reactions. — This type requires no explanation ; the main 
difficulty is to decide what degree of sound similarity between 
stimulus and reaction should be deemed sufficient for placing a 
reaction under this heading. The total number of different sounds 
used in language articulation is, of course, small, so that any two 
words are liable to present considerable chance similarity. Some 
time ago we estimated the average degree of sound similarity be- 
tween stimulus words and reaction words in a series of one hun- 
dred test records obtained from normal persons ; we found that on 
the average 14.53 P^r cent of the sounds of the stimulus words 
were reproduced, in the same order, in the reaction word. Our 
experience finally led us to adopt the following general rule : A 
reaction is to be placed under this heading when fifty per cent of 
the sounds of the shorter word of the pair are identical with sounds 
of the longer word and are ranged in the same order. 

Among sound reactions we occasionally find neologisms; for 
these a separate heading is provided. Possibly their occurrence 
may be taken as an indication of an exaggerated tendency to 
respond by sound reactions. 

Word Complements. — Here we include any reaction which, 
added to the stimulus word, forms a word, a proper name, or a 
compound word in common use. 

Particles of Speech. — Under this heading we include articles, 
numerals, pronouns, auxiliary verbs, adverbs of time, place and 
degree, conjunctions, prepositions, and interjections. 

Complete Dissociation. — Here are included reactions which ap- 
pear to be entirely unrelated to the corresponding stimulus words ; 
in the case of such reactions the stimulus words seem to act, as 
AschaflFenburg has pointed out, merely as signals for discharge. 
This subdivision contains several types of reactions which seem 
to be dependent upon the phenomenon of perseveration; it con- 
tains also the rather important type of neologisms. 



/ 



lyiuj OK-Auc< iic.i-n,i>j iVi:-iN A /\i^u j\. j. Ku^/\iNurr ^^O 

The phenomenon of perseveration occurs in cases in which one 
may observe an abnormal immobility of attention. To react nor- 
mally to a series of stimulus words requires on the part of the 
subject, in the first place, a certain alertness in order that he may 
grasp quickly and clearly the meaning of each word, and, in the 
second place, a prompt shifting of the mind from one reaction to 
the next. When such mental mobility is lacking the subject is 
liable to react not by a response adjusted to the stimulus word, 
but either by repeating a previous stimulus or reaction, or by 
giving a word associated to the preceding stimulus or reaction. 

The names of the different types of reactions included under the 
heading of perseveration are sufficiently descriptive ; we shall 
here refer only to those which require further definition. 

Association to Preceding Stimulus. — Here is placed any reac- 
tion that is shown by the frequency tables to be related to the 
stimulus preceding the one in question. Seeming or even obvious 
relationship, if not established by reference to the frequency 
tables, is desregarded. In the tables, however, the combination 
may not exist in direct order but only in reverse order, in which 
case the reaction is included here. The following examples may 
serve as illustrations : 

thief — night 

lion — pocket-book 

Lion — pocket-book is not found in the frequency tables, and is, 
therefore, an individual reaction ; thief — pocket-book, however, is 
found there ; pocket-book is, therefore, classed in this case as an 
association to preceding stimulus. 

table — fork 
dark — mutton 

Dark — mutton is not found in the frequency tables ; table- — mutton 
is also not found there in the direct order, but is found in the re- 
verse order, viz. : mutton — table; mutton is, therefore, classed in 
this case as an association to preceding stimulus. 

Association to Preceding Reaction, — If either the reaction in 
question or the preceding reaction happens to be one of the stim- 
ulus words in our list, and a relationship between the two be 
found to exist by reference to the frequency tables — whether in 
direct or in reverse order — the reaction in question is classed as 



324 A STUDY OF ASSOCIATION IN INSANITY [Oct. 

an association to preceding reaction. This is illustrated by the 
following examples: 

eating — table 

mountain — floor 

Mountain — floor is an individual reaction ; table — floor is found 
in the frequency tables ; floor is, therefore, classed as an associa- 
tion to preceding reaction. 

beau tifu I — flowers 
linnd.ow — red 
Window — red is an individual reaction ; red — flozvers is found in 
the frequency tables ; therefore, red is classed as an association 
to preceding reaction. 

In cases in which neither the reaction in question nor the pre- 
ceding reaction happens to be one of our stimulus words, but a 
relationship between them may be judged to exist without con- 
siderable doubt, the reaction in question is also classed here. 
Example : 

priest — father 
ocean — mother 
Ocean — mother is an individual reaction ; neither the word father 
nor the word mother is among our stimulus words ; but the asso- 
ciation between the words father and mother may be judged to 
exist without considerable doubt ; therefore, in this case mother is 
classed as an association to preceding reaction. 

In such cases as this personal equation must necessarily come 
into play ; comparative uniformity of judgment may, however, 
be attained by systematically excluding any reaction the relation- 
ship of which to the preceding reaction is subject to any consider- 
able doubt and by placing any such reaction in the unclassified 
group. 

Repetition of Previous Stimulus. — Here we place any reaction 
which is a repetition of any previous stimulus from amongst the 
ten next preceding, at the same time placing repetition of preced- 
ing stimulus under a separate heading. 

Neologisms. — Here we place the newly coined words, so com- 
monly given by the insane, excepting such as possess a sound 
relationship to the stimulus word, for which, as already stated, a 
special place in the classification has been provided. 



I9IO] GRACE HELEN KENT AND A. J. ROSANOFF 325 

Neologisms might be divided into three types, as follows: (i) 
those which arise from ignorance of language {comfort — un- 
coinfort, short — diminiatiire) ; (2) distortions of actual words, 
apparently of pathological origin and not due to ignorance 
{hungry — foodation, thief — dissteal) ; and (3) those which seem 
to be without any meaning whatever {scack, gehimper, hanrozu, 
dicitt). It is, however, impossible to draw clear-cut distinctions 
between these types, and for this reason we have made no pro- 
vision in our classification for such division. 

Unclassified Reactions. — This group is important, in the first 
place, because it is numerically a large one, and in the second 
place, because it contains certain fairly definite types of reactions 
which are placed here for the sole reason that we have not been 
able to find strictly objective criteria for their differentiation from 
other types. 

It has already been stated that the frequency tables, even to- 
gether with the appendix, fail to exhaust all normal possibilities 
of association, so that a certain small number of perfectly normal 
reactions must fall into the unclassified group. We submit the 
following examples : 

music — listen 

smooth — suave 

sour — curdled 

earth — mound 

Another type of reactions found in the unclassified group, 
though also normal, yet not obviously so until explained by the 
subject, is represented by those which originate from purely per- 
sonal experiences, such as the following, given by normal subjects : 

blossom — T .... 
hammer — / .... 

The first of these reactions is explained by the subject's ac- 
quaintance with a young lady, Miss T . . . . , who has been nick- 
named " Blossom," and the second is explained by the subject's 
having among her pupils at school a boy by the name of J ... . 
Hammer. 

It would be difficult to estimate the proportion of such reac- 
tions in the unclassified group, but we have gained the general 
22 



326 A STUDY OF ASSOCIATION IN INSANITY [Oct. 

impression that it is small. An attempt to place them in a separate 
group could be made only with the aid of explanations from the 
subjects; such aid in the case of insane subjects is generally un- 
reliable. Moreover, to class these reactions as strictly normal 
would perhaps be going too far, since their general value is 
obviously inferior to that of the common reactions ; and in any 
case in which they are given in unusually large numbers they 
must be regarded as manifestation of a tendency to depart from 
the normal to the extent to which they displace common reactions. 
The next type of reactions met with in the unclassified group 
is characterized by a peculiarly superficial, or non-essential, or 
purely circumstantial relationship to the stimulus. Such reactions, 
though occasionally given by normal subjects, are more often 
given by insane ones, and seem to be somewhat characteristic of 
states of mental deterioration which are clinically rather loosely 
described as puerilism. We offer the following examples, given 
by normal subjects : 

music — toivn 
sickness — summer 
child — unknown 
house — enter 

Still another type of reactions to be considered in this connec- 
tion consists of words which are in no way related to the corre- 
sponding stimulus words, but which arise from distraction of the 
subject by surrounding objects, sounds, and the like. In some 
cases the experimenter may be able to judge from the direction 
of the subject's gaze, from a listening attitude, and so on, that 
certain reactions are due to distraction. In other cases, particu- 
larly in cases of normal subjects, the fact that certain reactions 
are due to distraction may be determined by questioning the sub- 
ject on this point immediately after making the test. In work 
with insane subjects, as we have several times had occasion to 
point out, such aid is generally not available. 

The group of unclassified reactions includes also one more type 
of reactions which are of great importance both numerically and 
otherwise. These are the incolierent reactions, that is to say, re- 
actions which are determined neither by the stimulus words, nor 
by the agency of perseveration, nor by distraction. 



1910] GRACE HELEN KENT AND A. J. ROSANOFF 327 

Although the occurrence of incoherent reactions is hardly sub- 
ject to doubt, yet in no instance is it possible to establish with cer- 
tainty that a given reaction is of this type, for in no instance can a 
remote, or an imagined, or a merely symbolic relationship between 
stimulus and reaction be positively excluded. Some, indeed, would 
assert that some such relationship must necessarily exist in every 
instance, at least in the domain of the subconscious. This cir- 
cumstance necessitates the placing of this type of reactions in the 
unclassified group. 

In practice it may be found advisable in some cases to analyze 
the unclassified reactions with a view to ascertaining to what ex- 
ent each of the various types is represented among them. But 
one here treads on slippery ground, and one must be continually 
warned against the danger of erroneous conclusions. 

§ 5. Order of Preference. 

After having developed the classification here proposed we 
found that there was still considerable room for difference of 
opinion in the placing of many reactions, owing to the circum- 
stance that in many cases a reaction presents features which ren- 
der it assignable under any one of two or more headings. To 
leave the matter of preference in grouping to be decided in each 
case according to the best judgment of the experimenter would 
mean introducing again the play of personal equation, and would 
thus court failure of all our efforts to accomplish a standardiza- 
tion of the association test. Therefore, the necessity of establish- 
ing a proper order of preference for guidance in the application 
of the claissification became to us quite apparent. 

In the arrangement of the order of preference we were guided 
mainly by two principles, namely: (i) as between two groups 
of unequal definition, the one which is more clearly defined and 
which, therefore, leaves less play for personal equation is to be 
preferred; (2) as between two groups of equal definition, the 
one which possesses the greater pathological significance is to be 
preferred. In accordance with these principles we have adopted 
the order of preference shown in Table III., placing every re- 
action under the highest heading on the list under which it may 
be properly classed. 



328 A STUDY OF ASSOCIATION IN INSANITY [Oct. 

TABLE III. 

1. Non-specific (common). 

2. Doubtful reactions. 

Individual Reactions. 

3. Sound reactions (neologisms). 

4. Neologisms without sound relation. 

5. Repetition of preceding reaction. 

6. Reaction repeated five times. 

7. Repetition of preceding stimulus. 
t 8. Derivatives. 

9. Non-specific reactions. 

10. Sound reactions (words). 

11. Word complements. 

12. Particles of speech. 

13. Association to preceding stimulus. 

14. Association to preceding reaction (by frequency tables). 

15. Repetition of previous reaction. 

16. Repetition of previous stimulus. 

17. Normal (by appendix). 

18. Association to preceding reaction (without frequency tables). 
Id. Unclassified. 

§ 6. Errors Involved in the Use of Arbitrary Objective 

Standards. 

It may readily be seen that such definiteness and uniformity as 
this classification possesses results from the introduction of more 
or less arbitrary criteria for the differentiation of the various 
types of reactions. The question might arise, To what extent do 
the distinctions thus made correspond to reality? To consider, 
for instance, our rule for the placing of sound reactions (50 per 
cent of the sounds of the shorter word to be present, in the same 
order, in the other word) : when a given reaction {man — minstrel) 
is in accordance with the rule assigned under the heading of 
sound reactions, can it be assumed that sound similarity and not 
some other relationship is the determining factor of the associa- 
tion in question? Or when in a given instance (cabbage — cobii'eb) 
the sound similarity falls somewhat short of the standard required 
by the rule, can it be assumed that sound similarity is not, after all. 
the determining factor? 

Similar questions may, of course, arise in connection with other 
subdivisions. 

It must, indeed, be conceded that objective methods can reveal 
but indirectly and with uncertainty the inner mechanism which 
produces any association and that in any given instance it would be 
impossible to establish the correctness of grouping in accordance 
with such methods. However, to decide that question for any 
given reaction is really not necessary in practice, since au error 



I9IO] GRACE HELEN KENT AND A. J. ROSANOFF 329 

made through wrongly placing one, two, or three reactions under 
any heading is of no significance ; the types acquire importance 
only when represented by large numbers in a record under consid- 
eration ; and when many reactions fall under a single heading the 
likelihood of error, as affecting the record as a whole, is by that 
fact alone greatly reduced. 

The whole question might more profitably be approached from 
another point of view : To what extent are the distinctions of this 
classification useful? An answer to this question can be found 
only in the results. 

§ 7. Analysis of Pathological Material. 

We present in Table IV. the results of a statistical examination 
of the records obtained from certain groups of normal subjects 
and from some groups of insane subjects. 

The normal groups have been studied for the purpose of deter- 
mining the frequency and manner of occurrence among normal 
subjects of the various t\'pes of abnormal reactions. It seemed 
best for this purpose to consider separately the records of those 
subjects who gave an unusually large number of individual re- 
actions. Fifty-three records containing fifteen or more individual 
reactions were found after a fairly diligent search among our 
normal test records. In the other groups of subjects — persons of 
common school education, persons of collegiate education, and 
children — we included no records containing more than ten in- 
dividual reactions. 

The more striking departures from average normal figures are 
indicated in the table by the use of heavy type. 

This table reveals some special associational tendencies as oc- 
curring in connection with the psychoses studied. A better in- 
sight into the nature of these tendencies can be gained by a 
special analysis of the test records of each clinical group. 

DEMENTIA PRECOX. 

In this psychosis we find the average number of individual re- 
actions far exceeding not only that of the normal but also that of 
any other psychosis which we have studied. To a corresponding 
extent we find the average number of the highest type of nomial 
reactions — the common specific reactions — reduced. 

While almost every type of individual reactions shows here an 



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igiO] GR.\CE HELEN KENT AND A. J. ROSANOFF 33I 

increase over the normal averages, the most striking increases are 
shown by the table to be in the groups of unclassified reactions, 
neologisms, sound reactions, and some tj'pes of perseveration. A 
further examination of the individual test records shows that 
there is no uniformity of associational tendencies in this clinical 
group, but that several tendencies are more or less frequently met 
with either alone or in various combinations. Yet some of these 
tendencies, when appearing at all prominently, are so highly 
characteristic of dementia prascox as to be almost pathognomonic. 
Among these may be mentioned : ( i ) the tendency to give neol- 
ogisms, particularly those of the senseless type; (2) the tendency 
to give unclassified reactions largely of the incoherent type ; and 
(3) the tendency toward stereotypy manifested chiefly by ab- 
normally frequent repetitions of the same reaction. Fairly char- 
acteristic also is the occasional tendency to give sound reactions. 
Again, occasionally one encounters pronounced perseveration, and 
at least two of our subjects gave a good many unclassified reactions 
obviously due to distraction. 

It must be noted that not infrequently cases of dementia prse- 
cox give test records that cannot be distinguished from normal. 
It seems that the pathological associational tendencies constitute 
merely a special group of symptoms, some of which may be ex- 
pected to be manifest in cases which have reached a state of ad- 
vanced mental deterioration, but may not necessarily be present 
in the early stages of the disease. On the other hand there is evi- 
dence to show that these tendencies may in some cases appear 
among the earliest manifestations. This matter will be referred 
to again. 

Thus the test records of dementia prascox depart from the 
normal not sharply but by a gradual shading off. We find similar 
gradual transitions between dementia prsecox and other psychoses. 
For this work we selected cases in which the diagnoses were es- 
tablished with reasonable certainty. Whether or not in cases of 
doubtful clinical classification this association test may be of aid 
in determining the diagnosis, is a question that must for the pres- 
ent remain open. 

We submit herewith copies of test records. The numbers which 
appear after the reactions indicate in each case the reaction tj-pe, 
in accordance with Table III. (p. 328) ; common specific reactions 
are not numbered. 



332 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 4752. — H. J. 

incoherent. 

Table — meadow 19 

Dark— black 

Music — sweet 

Sickness — dead 2 

Man — manion 3 

Deep — near 19 

Soft — sooner 19 

Eatinif— formble 4 

Mountain— gair 4 

House — tenible 4 

Black— benched 4 

Mutton — ranched 4 

Comfort — bumble 4 

Hand — semble 4 

Short — simber 4 

Fruit— narrow 13 

Butterfly— Ben 19 

Smooth— gum 19 

Command — bramble 19 

Chair — low 

Sweet — temper 19 

Whistle— bensid 4 

Woman — hummery 4 

Cold — gunst 4 

Slow — bemper 4 

Wish— tip 19 

River — gumper 4 

AMiite— Andes 19 

Beautiful — gimper 4 

Window— hummer 4 

Rough— geep 4 

Citizen — humper 4 

Foot — zuper 4 

Spider— gumper 4 



Neologisms ; some unclassified reactions, mostly 



Needle — himper 4 

Red— grumper 4 

Sleep — moop 4 

Anger — rumble 19 

Carpet — slampcr 4 

Girl — hinker 4 

High — humper 4 

Working— gumpip 4 

Sour— imper 4 

Earth — gumper 4 

Trouble — humper 4 

Soldier — guipper 4 

Cabbage — phar 4 

Hard- her 12 

Eagle — damnomott 4 

Stomach — dumper 4 

Stem— gumper 4 

Lamp — huntznit 4 

Dream — hungnot 4 

Yellow — bampir 4 

Bread — gumper 4 

•Justice — sidnerber 4 

Boy — eeper 4 

Light— huntznit 4 

Health — geeper 4 

Bible — himpier 4 

Memory — hummer 19 

Sheep-^hunner 4 

Bath— bemnit per 4 

Cottage — gumper 4 

Swift--dumper 4 

Blue — dipper 19 

Hungry — hummer 3 

Priest — rump 19 



19 



Ocean— himmer . . 

Head— hiniper 

Stove — gamper .... 

Long — humble 19 

Religion— gumper 
Whiskey — numper 
Child — himmer . . . 
Bitter — gehimper . 
Hammer — gueep . . 
Thirsty — humper . 

City — deeper 

Square — hummer . . 
Butter — bimper . . 
Doctor — harner . . . 

Loud — hamer 

Thief — himmer .... 

Lion — humor 19 

Joj- — gumpier 

Bed— boomer 

Heavy — doomer 

Tobacco — per 1 

Baby— boomer 

Moon— gumper 

Scissors — gumper 

Quiet — humper 

Green — gueet 

Salt— rummer 

Street — numper 

King — himper 

Cheese— guinter 

Blossom — >-unger 

Afraid— yunger 



Case No. 5183. — G. D. Neologisms; numerous unclassified reactions, 
mostly incoherent; some sound neologisms. 



Table^muss 19 

Dark— gone 19 

Music — caffa 4 

Sickness— monk 19 

Man — ^boy 

Deep — lesson 19 

Soft — ness 4 

Eating— pie 

Mountain— Gus 19 

House — muss 15 

Black— court 19 

Mutton — beef 

Comfort — ness 4 

Hand— koy 4 

Short — ness 4 

Fruit— dalb 4 

Butterfly— flack 4 

Smooth— mess 19 

Command — cork 19 

Chair- ness 4 

Sweet — Bess 17 

Whistle—toy 

Woman — girl 

Cold— cork 15 

Slow — mass 19 

Wish — veil 4 

River — mouth 17 

White— cast 17 

Beautiful — ness 4 

Window — crow 19 

Rough— ratter 19 

Citizen— zide 4 

Foot — malloy 4 

Spider — straw 19 



Needle — cast 15 

Red— Roman 19 

Sleep — scack 4 

Anger — gois 4 

Carpet— noise 13 

Girl— call 18 

High — hort 4 

Working— kaffir 19 

Sour— romerscotters .... 4 

Earth— bell 19 

Trouble — tramine 4 

Soldier^gas 19 

Cabbage — cor 4 

Hard— kalbas 4 

Eagle— bell 15 

Stomach — chenic 4 

Stem— trackstar 3 

Lamp — loss 19 

Dream — melso 4 

Yellow — ormondo 4 

Bread — life 

Justice — quartz 19 

Boy — nellan 4 

Light — cor 4 

Health — haJlenbee 4 

Bible — book 

Memory — bike 19 

Sheep — armen 4 

Bath — cor 4 

Cottage — callan 4 

Swift — swar 3 

Blue — blacksen 4 

Hungry — scatterbuck ... 4 
Priest — canon 17 



Ocean — men 19 

Head— will 19 

Stove — somen 4 

Long — lass 19 

Religion — cor 4 

A\'hiskev— hanrow 4 

Child— vand 4 

Bitter— bike 15 

Hammer— hemmel 3 

Thirstv — cass 4 

City— cor 4 

Square — malice 19 

Butter— back 19 

Doctor — ness 4 

Loud — arman 4 

Thief— cast 15 

Lion— loss 15 

Joy — kaflSr 15 

Bed — banrow 4 

Heavy — cast l.'> 

Tobacco — colrow 4 

Baby— boil 19 

Moon— padoc 4 

Scissors — kantow 4 

Quiet — kilroe 4 

Green— graft 10 

Salt — semen 10 

Street— pess 4 

King— guess 19 

Cheese — tiffer 4 

Blossom — cad 19 

Afraid— mellows 19 



I9IOJ 



GRACE HELEN KENT AND A. J. ROSANOFF 



333 



Case No. 1500. — D. V. Considerable number of neologisms; stereotypy 
manifested partly in a tendency toward frequent repetition of certain re- 
actions but mainly in a persistent tendency to make use of the grammatical 
form of present participle, giving rise to numerous doubtful reactions. 



Table — stand 

Dark — lonesome 

Music — playine: 

Sickness — disease 

Man — hiding 19 

Dfep^imreokless 4 

Soft — beginning 19 

Eating— plenty 

Mountain — high 

House — standing 6 

Black — grivelling 4 

Mutton — plenty 15 

Comfort— laying 19 

Hand — disease 15 

Short — wTiting 13 

Fruit — coming 19 

Butterfly— flying 

Smooth— glimming 4 

Command — master 

Chair — standing 6 

Sweet — sugar 

Whistle — blowing 

Woman — loving 

Cold— cellar 19 

Slow — coming 15 

Wish — dreaming 2 

River— divided 19 

>\Tiite— wall 

Beautiful — pleasant 1 

Window — breaking 2 

Rough — tumble 

Citizen — gentleman 

Foot — sweating 19 

Spider — biting 2 



Needle — stinging 2 

Red — coloring 

Sleep — dreaming 

Anger— widing ... 4 

Carpet — cleaning 

Girl— pretty 1 

High— degrace 4 

Working — nobody 19 

Sour — boiling 4 

Earth — disgrace 19 

Trouble — plenty 

Soldier — shooting 13 

Cabbage — welldebell 4 

Hard — caming 4 

Eagle — setting 19 

Stomach — degrivel 4 

Stem— biting 19 

Lamp — burning 

Dream — walking 19 

Yellow— blowing 15 

Bread — making 

Justice — unpossible 4 

Boy — growing 2 

Light— stand 6 

Health— raising 19 

Bible — teaching 2 

Memory — together 12 

Sheep — weeding 19 

Bath— held 19 

Cottage — standing 2 

Swift — incuriossable .... 4 

Blue — smooven 4 

Hungry — uncareless 4 

Priest — going 19 



Ocean — moving 2 

Head — setting 15 

Stove — warm 

Long — slowly 2 

Religion — everrthing .. .19 

Whiskey — burning 

Child— bom 

Bitter— taking 19 

Hammer — hitting 2 

Thirsty — drinking 

City— welldebell 4 

Square — taking Ij 

Butter— soft 

Doctor — instrument 19 

Loud — speaking 2 

Thief— gitting 4 

Lion — scared 17 

Joy — playing 2 

Bed — laying 2 

Hea\-y — raisen 4 

Tobacco — eating 19 

Baby — bom 

Moon — shining 

Scissors — cutting 

Quiet — hitting 15 

Green— landed 19 

Salt— throwing 19 

Street — walking 

King — tension 19 

Cheese — eating 

Blossom — growing 2 

Afraid — nobody 



Case No. 5138. — C. J. Unclassified reactions, mostly incoherent. 



Table— tablecloth 

Dark — forward 19 

Music — instrument 

Sickness— fluid 19 

Man — hemale 4 

Deep — steep 

Soft— hard 

Eating — mountain 19 

Mountain — raven 19 

House — shutter 17 

Black— blue 

Mutton — beef 

Comfort — discomfort .... 

Hand — wrist 

Short— tall 

Fruit— vegetable 

Butterfly— bee 

Smooth — rough 

Command — orders 

Chair— sofa 

Sweet — sour 

"Whistle— ftfe 

Woman — girl 

Cold — warm 

Slow — faster 2 

Wish— not 2 

River — neck 17 

White— blue 

Beautiful— homel.v 

Window — sill 

Rovigh — paint 19 

('it izen — pedestrian 19 

Foot — rose 19 

Spider — towel 19 



Needle— lifter 19 

Red— dove 19 

Sleep — coat 13 

Anger — smile 19 

Carpet— gas 19 

Girl— kite 19 

High — cow 19 

Working — candy 19 

Sour — peach 17 

Earth— balloon 19 

Trouble — grass 13 

Soldier — brass 17 

Cabbage— flea ...19 

Hard— cat 19 

Eagle — negro 10 

Stomach — winter 19 

Stem— leaf 

Lamp — cloth 19 

Dream — slumber 

Yellow — pink 

Bread — glass 19 

Justice — coal 19 

Boy — maid 

Light — shine 

Health — pale 17 

Bible— leaf 

Memorj' — grief 19 

Sbeep— giraffe 19 

Bath — soap 

Cottage — scene 19 

Swift — slow 

Blue — piece ... 19 

Hungry — food 

Priest— minister 



Ocean — waves 

Head — black 

Stove— lid 

Long — short 

Religion — Christian .... 

WTiiskev- malt 

Cliild- baby 

Bitter — sweet 

Hammer— nail 

Thirsty— water 

City— steeple 19 

Square — marble 19 

Butter — bread 

Doctor — aster 19 

Loud— fog 19 

Thief— Mary 19 

Lion — tiger 

Joy — glad 

Bed— ^eet 

Heavy — light 

Tobacco — smoke 

Baby — powder 

Moon — sky 

Scissors — handle 

Quiet— sing 19 

Green — pink 

Salt— chimney 19 

Street— block 

King — crown 

Cheese — tea 17 

Blossom — leaves 

Afraid — frighten 



334 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 17979. — R- T. Unclassified reactions, mostly incoherent. 



Table— full 19 

Dark — coldness 2 

Music — aeronaut 19 

Sickness — better 

Sfan^exlension 19 

Deep — electrician 19 

Soft— harden 2 

Eating^ — stomach 

Mountain — Lord 19 

House — roof 

Black — darkness 

Mutton — working 10 

Comfort— ahead 12 

Hand — mercury 19 

Short — have 12 

Fruit— flavor 19 

Buterfly— plant 13 

Smooth — level 

Command — obedient .... 

Chair— rest 

Sweet— polish 19 

^Miistle — note 

Woman — comfort 

Cold — pleasant 1 

Slow — move 

Wish— wealth 

River— shell 19 

^^'hite — change 19 

Beautiful— sat 19 

Window— temperature . .19 

Rough — shell 15 

Citizen — soldier 

Foot — travel 

Spider — web 



Needle — point 

Red— temperature 15 

Sleep — rest 

Anger — temper 

Carpet— court 10 

Girl— birth 10 

High— dirt 19 

Working — ease 

Sour— bait 4 

Earth — vexation 19 

Trouble — business 

Soldier — obedient 2 

Cabbage— fell 19 

Hard — solid 

Eagle — government 10 

Stomach — chest 

Stem— wish 19 

Lamp — brilliancy 17 

Dream — unso 4 

Yellow — color 

Bread — crust 

.Tustice — truth 

Hoy — obedient 

Light— heart 2 

Health— feeling 

Bible — scripture 

Memory — saying 19 

Sheep^wooi 

Bath— get 19 

Cottage — morrell 4 

Swift — good 1 

Blue— look 19 

Hungry — have 12 

Priest — scripture 15 



Ocean — supply 19 

Head— manager 17 

Stove — shake 19 

Long— journey 

Religion — thought 1 

Whiskey — lusk 4 

Child— wish 15 

Bitter — enmalseladiga .. 4 

Hammer — efface 19 

Thirsty — want 

City — comforts 15 

Square — crown .... ... .19 

Butter— flavor 15 

Doctor— dram 19 

Loud —temper 15 

Thief— catched 2 

Lion — crown 15 

•Joy- pleasure 1 

Bed— comforts 

Heavy — thoughts 1 

Tobacco — changes 15 

Baby — pleasure 1 

Moon — brilliancy 2 

Scissors — edge 

Quiet — baptism 19 

Green — autumn 19 

Salt— gather 19 

Street — thoroughfare .... 

King — crown 

Cheese — flavor 15 

Blossom — wood 17 

.\fraid— downhearted . . .17 



Case No. 3307. — G. F. Unclassified reactions, mostly incoherent; slight 
tendency to respond by sound reactions. 



Table— desk 

Dark — blue 

Music — stars 13 

Sickness — trees 19 

Man — menace 10 

Deep — soap 19 

Soft— excited 19 

Eating — spelling 10 

Mountain — marbles 19 

House — train 19 

Black— bed 19 

Mutton— bu tton 10 

Comfort— steak 13 

Hand— flexible 10 

Short— umbrella 17 

Fruit— blanket 10 

Butterfly— grass 

Smooth— sheet 19 

Command — carpet 19 

Chair — store 19 

Sweet — flower 

Whistle — linen 19 

Woman — water 19 

Cold — coal 

Slow— ferry 17 

Wish — sample 19 

River— shades 19 

White — blue 

Beautiful — suspender . . .19 

Window — wood 

Rough— chisel 19 

Citizen — ruler 

Foot — snake 19 

Spider — fly 



Keedle — bird 13 

Red— green 

Sleep — opening 19 

Anger— angry 

Carpet— stitching 19 

Girl — madam 17 

High — ceiling 

Working — easy 

Sour— warm 19 

Earth- heaven 

Trouble — astonished 19 

Sr.ldier — man 1 

Cabbage — carrot 

Hard — softness 2 

Eagle — parrot 

Stomach— mind 19 

Stem— stable 10 

Lamp — oil 

Dream — awake 

Yellow — darkness 2 

Bread — rough 19 

Justice — male 19 

Boy — buoy 10 

Light — standing 19 

Health— very 12 

Bible — ashamed 19 

^remor>-~staring 19 

Sheep — stock 

Bath — sponge 

Cottage — house 

Swift — mouse 19 

Blue— fall 19 

Hungry- appetite 

Priest— pastor 



Ocean— waves 

Head— hat 

Stove — blackening 2 

Long— garden 19 

Religion — goodness 1 

Whiskey — Kummell 17 

Child — woman 1 

Bitter — coughing 19 

Hammer — sofa 19 

Thirsty— pillow 18 

City — united 19 

Square — oblong 

Butter — lard 

Doctor — physician 

Loud — easy 

Thief— burglar 

Lion — tiger 

.Tov — healthv 2 

Bed— thread 10 

Heavy— gloves 17 

Tobacco — cigar 

Baby— hood 11 

Moon — stars 

Scissors— knife 

Quiet — recollect 17 

Green — ring 19 

Salt— pencil 19 

Street— bushes 19 

King — Germany 17 

Cheese — rice 17 

Blossom — pepper 19 

Afraid— allspice IS 



I910J 



GR.A.CE HELEN KENT AND A. J. ROSANOFF 



335 



Case No. 971. — O. M. Unclassified reactions, mostly incoherent. 



Table— vote 19 

Dark — plenty 19 

Music — health 19 

Sickness — fright 

Man — manager 10 

Deep— slow 19 

Soft— pepper 19 

Eating— vanity 19 

Mountain— slept 19 

House — courage 19 

Black— funeral 

Mutton— age 19 

Comfort— slide 19 

Hand — credit 19 

Short — Simpson 17 

Fruit — phvsician 19 

Butterfly— torment 19 

Smooth — button 17 

Command— scarf 19 

Chair— rage 19 

Sweet — cider 17 

Whistl^-lace 19 

Woman— debt 19 

Cold— powderly 4 

Slow — telephone 19 

Wish— regret 17 

River— herald 19 

White— black 

Beautiful— jolly 19 

Window — pane 

Rough— duty 19 

Citizen — ward 17 

Foot — minister 19 

Spider — handsome 19 



Needle— pin 

Red — white 

Sleep — apple 13 

Anger — sour 19 

Carpet — wool 

Girl— boy 

High— low 

Working— height 13 

Sour — pitcher 19 

Earth— clam 19 

Trouble — necessity 9 

Soldier— marine 

Cabbage — watermelon . .17 

Hard — cracker 17 

Eagle— bright 19 

Stomach — back 

Stem — stimulant 10 

Lamp — hair 19 

Dream — knees 19 

Vellow — amen 12 

Bread— general 19 

Justice — no 2 

Boy — grass 19 

Light— thought 9 

Health — depression 17 

Bible — judger 4 

Memory — stomach 19 

Sheep — crusade 19 

Bath— labor 19 

Cottage — cotton 10 

Swift— depth 19 

Blue — crimson 17 

Hungry — alloyed 19 

Priest — politicians 17 



Ocean — sea 

Head — cranium 

Stove— soft 19 

Long — biles 4 

Religion — bunion 10 

Wh iskev — vinegar 17 

Child— edge 19 

Bitter— bom 10 

Hammer — wood 

Thirstj'— cradle 19 

City— flames 19 

Square — eating 19 

Butter— dirt 19 

Doctor — malefactor 19 

Loud — quinine 19 

Tliief— joy 19 

Lion — sage 19 

Joy — thorn 19 

Bed — draper 19 

Hea\'y — close 19 

Tobacco — weed 

Baby— stop 19 

Moon — starch 19 

Scissors — crepe 17 

Quiet— bustle 19 

Green — color 

Salt— throw 19 

Street— ferment 19 

King — jaunce 4 

Cheese — tepid 19 

Blossom — woman 9 

Afriad — shame 17 



Case No. 01655. — E. H. Unclassified reactions, mostly incoherent. 



Table— cent 19 

Dark— sweet 19 

Music — delighted 2 

Sickness — pop 19 

Man— change 19 

Deep — pass 19 

Soft— drop 19 

Eating— fair 19 

Mountain — heavy 19 

House — fate 19 

Black— right 19 

Mutton— with 12 

Comfort — indeed 12 

Hand— span 10 

Short — stop 

Fruit— dip 19 

Butterfly — home 19 

Smooth — days 19 

Command— stop 15 

Chair — pledge 19 

Sweet — right 15 

Whistle — home 15 

Woman — Louisa 17 

Cold— chair 16 

Slow— aid 19 

Wish— book 2 

River — shoes 19 

■\Vhite— ouch 12 

Beautiful— not 12 

Window — papers 19 

Rough — lettuce 19 

Citizen — money 17 

Foot— stand 

Spider — socks 19 



Needle — drops 15 

Red — glass 17 

Sleep — suits 19 

Anger — suits 5 

Carpet— hat 19 

Girl — president 19 

High — pass 19 

Working — knock 19 

Sour — cake 19 

Earth — home 

Trouble — news 17 

Soldier — name 19 

Cabbage — rule 19 

Hard— rope 19 

Eagle— in 12 

Stomach— potato 17 

Stem — pick 

Lamp — berry 18 

Dream — book 

Yellow — lettuce ID 

Bread — chews 17 

Justice — night 15 

Boy— bat 17 

Light — rasp 19 

Health— off 12 

Bible — comforter 2 

Memory — candy 19 

Sheep — eat 

Bath— sweet 19 

Cottage— walk 19 

Swift— reason 19 

Blue— dot 19 

Hungry — swift 16 

Priest— birth 19 



Ocean — stop 15 

Head — strap 19 

Stove — pot 17 

Long — name 

Religion — dav 13 

Whiskev— take 19 

Child— jaw 17 

Bitter— licorice 17 

Hammer — sound 

Thirsty— cards 19 

City— dice 18 

Square — muff 19 

Butter— stick 19 

Doctoi^perfect 19 

Loud — walk 15 

Thief— jail 

Lion — cow 

Joy— nail 19 

Bed — new 19 

Heavy — down 12 

Tobacco — prize 19 

Baby — new 15 

Moon — new 

Scissors — teach 19 

Quiet — man 1 

Green — water 17 

Salt — monev 19 

Street— right 15 

King — girl 19 

Cheese — house 19 

Blossom — work 1 

Afraid — jars 19 



336 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case M. F. (from Hudson River State Hospital), 
tions, mostly incoherent. 



-Unclassified reac- 



Table— heat II) 

Dark— succeed 19 

Music — benefit 19 

Sickness — steep 19 

Man — dicut 4 

Deep — recti! V 19 

Soft— bed .'. 

Eating — dozy 10 

Mountain — tulu 4 

House — sails 10 

Black — sunrise 10 

Mutton— tuition 19 

Comfort — blasphemous . .19 

Hand — doing 

Short— pest l9 

Fruit — charm 19 

Butterfly— doctor 19 

Smooth— border 19 

Command — right 

Chair — distill 19 

Sweet — noticed 19 

Mil istle— stead 19 

Woman — splice 19 

Cold— strap 19 

Slow— chief 19 

Wish — shame 19 

River— word 19 

WTiite — color 

Beautiful— better 19 

Window — dull 10 

Rou^h— bright 18 

Citizen — chum 19 

Foot- relax 19 

Spider— float 19 



Needle — action 19 

Red— stout 19 

Sleep— lazy 17 

Anger — anguish 

Carpet — knowledge 19 

Girl— first in 

High— hand 19 

Working — power 17 

Sour — mud 19 

Earth— sky 

Trouble — sorrow 

Soldier — manhood '2 

Cabbage — righteous 19 

Hard — beaten 17 

Eagle— dog 19 

Stomach — paste 19 

Stem— dust 10 

r^^mp- fall 19 

Dream — idle 17 

Yellow — zone 19 

Bread — pan 17 

Justice — tricks 17 

Boy— barrel 19 

Light — powers 15 

Health — kindness 19 

Bible — story 

Memory — pillow 19 

Sheep — veil 10 

Bath— ink 19 

Cottage — paper 19 

Swift — arrow 

Blue — cold 

Hungry — dyes 10 

Priest — cloak 19 



Ocean — pilot 17 

Head— tin 19 

Stov^-plate 17 

Long — trouble 19 

Religion — soap 19 

^\'hiskey— starch 13 

Child— night 19 

Bitter — contentment . . . .19 

Hammer — shortness 19 

Thirsty— knife 19 

City — mind 19 

Square — truth 2 

Butter— biscuit 

Doctor — piles 17 

Loud — distrust 19 

Thief— babies 19 

Lion — hair 

Joy — eyesight 19 

Bed — dievos 4 

Heavy — determined 19 

Tobacco— health 19 

Baby— wood 19 

Moon— heat 15 

Scissors — squeeze .19 

Quiet — tears 19 

Green— fall 15 

Salt— soft 10 

Street— wait 19 

King — inches 19 

Cheese — doctor 15 

Blossom — fades 19 

Afraid — hearts 2 



Case No. 01552. — E. J. D. Unclassified reactions, mostly incoherent. 



Table — unicorn 19 

Dark — African 17 

Music — love 

Sickness — slumber 17 

Man — minstrel 10 

Deei>^river 

Soft — highwayman 19 

Eating— England 19 

Mountain — pleasure .... 1 

House — Christianity 10 

Black — directory 19 

Mutton^capers 19 

Comfort— mankind 12 

Hand — surface 19 

Short— court 10 

Fruit — pleasure 1 

Butterfly — dispatcher . ..19 
Smooth — navigation ... .19 
Command — 

administration. .19 

Chair — time 19 

Sweet— office 13 

Whistle— foreign 19 

Woman— usefulness 1 

Cold— frigid 

Slow — vocation 19 

Wish — longing 

River — tributary 17 

White— island 13 

Beautiful— unseen 19 

Window — frugal 19 

Rough— nautical 19 

Citizen— pedestrian 19 

Foot— laugh 19 



Spider — jungle 19 

Needle — man 9 

Red— monde 4 

Sleep — resustication 4 

Anger — uncared 19 

Carpet^ — foreign 15 

Girl— celt 19 

High — wine 10 

Working — prayer 19 

Sour— flower 10 

Earth— tariff 19 

Trouble — ledger 19 

Soldier — work 1 

Cabbage — ancient 19 

Hard — provender 19 

F^agle — school 19 

Stomach — bowels 

Stem — tide 

Lamp — scientific 19 

Dream — somno 4 

Yellow — pain 19 

Bread — populous 19 

Justice — thwart 19 

Boy — globe 10 

Light — female 13 

Health— linen 10 

Bible — divine 17 

Memory — current 19 

Sheep — water 

Bath— rain IS 

Cottage — journal 19 

Swift— yacht 17 

Blue — novel 10 

Hungry — viand 2 



Priest — pedestrian 15 

Ocean — commotion 10 

Head — sugar 19 

Stove — wTiter 19 

Long — mingle 19 

Religion — tent 19 

Whiskev — a>pulency .... 4 

Child-Editor 19 

Bitter— backward 19 

Hammer — youth 19 

Thirsty— salt 17 

City— gentler 19 

Square — angelus 19 

Butter — pastry 17 

Doctor — veterinary 17 

Loud — muslin 19 

Thief— grocer 19 

Lion — trip 19 

Joy — penance 17 

Bed — granite 19 

Heavy — note 19 

Tobacco — vanese 4 

Bab3' — school 15 

Moon — element 19 

Scissors — elderlv 19 

Quiet— trinity ' 19 

Green — commissioner . . .19 

Salt— strength 19 

Street— voyager 19 

King — sorrow 19 

Cheese — holiday 19 

Blossom — parks 19 

Afraid— stamina 17 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



337 



Case No. 667. — C. L. Pronounced stereotypy. Following note on test 
record: "Many attempts were made to secure a reaction other than * cat/ 
but usually without success ; the reaction cold — zvarm was given spontan- 
eously and with apparent interest; most reactions were given only in 
response to much urging, or else mechanically, without attention." 



Table — cat 6 

Dark— rat IS 

Music — shoe 19 

Sickness — cat 6 

Man— boy 

Deep — cat 6 

Soft— hat 19 

Eating — cat 6 

Mountain — hit 19 

House — gold 19 

Black— woman 9 

Mutton— get 19 

Comfort — cousin 19 

Hand— Jesus 19 

Short— hat 15 

Fn]it— hand 16 

Butterfly — going 19 

Smooth — hat 15 

Command — boy 

Chair— hat 15 

Sweet — cat 6 

Whistle— boy 

Woman — cat 

Cold— warm 

Slow— button 19 

Wish— cat 6 

River — cat 5 

White^rat 15 

Beautiful — good 1 

Window — wheel 19 

Rough— good 9 

Citizen^candy 19 

Foot— cat 6 

Spider — dog 19 



Needle — cat 6 

Red— button 15 

Sleep — cat 6 

Anger — go 15 

Carpet— cat 6 

Girl- in 12 

High— little 19 

Working — cold 19 

Sour— cat 6 

Earth— tag 19 

Trouble— cat 6 

Soldier— cat 5 

Cabbage — cat 5 

Hard — cat 5 

Eagle — cat 5 

Stomach — cat 

Stem — hat 15 

Lamp — cat 6 

Dream — cat 5 

Yellow — cat 

Bread — cat 5 

Justice — cat 5 

Boy — cat 5 

Light — eat 5 

Health— cat 5 

Bible— cat 5 

Memory — cat 5 

Sheep — cat 5 

Bath— cat 5 

Cottage — cat 5 

Swift— cat 

Blue — cat 5 

Hungry — cat 5 

Priest — cat 5 



Case No. 6oo6. — E. T. S. Stereotypy. 



Table— eat 

Dark — unkindness 19 

Music^beautiful 1 

Sickness — suff^ering 

Man— good 1 

Deep — unkindness 15 

Soft — unkindness 5 

Eating — digesting 

Mountain — low 

House — small 1 

Black — darkness 

Mutton — good 1 

Comfort — home 

Hand — useful 1 

Short— useful 5 

Fruit — healthy 

Butterfly— beautiful 1 

Smooth— unkindness . . . .15 

C-ommand — great 9 

Chair — useful 1 

Sweet— healthy 15 

Whistle— beautiful 6 

Woman — go^^d 1 

Cold— unhealthy 19 

Slow— good 6 

Wish — always 12 

River — needed 6 

Whit^pretty 1 

Beautiful — trees 

Window — needed 6 

Rough — unneeded 4 

Citizen — needed 6 

Fo<it — needed 2 

Spider — needed 5 



Needle — needed 5 

Red— beautiful 2 

Sleep— beautiful 1 

Anger — needed 6 

Carpet — needed 5 

Girl — needed 5 

High— height 

Working — needed 6 

Sour — needed 5 

Earth — needed 5 

Trouble— trust 10 

Soldier — needed 6 

Cabbage — needed 5 

Hard — trouble 

Eagle — beautiful 6 

Stomach — trouble 

Stem— shoot 10 

Lamp — light 

Dream — pleasant 1 

Yellow — pretty 1 

Bread — good 1 

Justice — needed 6 

Boy—needed 3 

Light— pretty G 

Health — needed 

Bible — needed 5 

Memorj' — needed 2 

Sheep — needed 5 

Bath— needed 5 

Cottage — needed 5 

Swift — needed 5 

Blue — pretty 1 

Hungry— food 

Priest— Father 



Ocean — cat 5 

Head — cat 5 

Stove — cat 5 

Long — cat 5 

Religion — cat 5 

Whiskey — cat 5 

Child— cat 5 

Bitter— cat 5 

Hammer — cat 5 

Thirsty — cat 5 

City — cat 5 

Square — cat 5 

Butter— cat 5 

Doctor— cat 5 

Loud — cat 5 

Thief— cat 5 

Lion — cat 

Joy— cat 5 

Bed — cat 5 

Heav>' — cat 5 

Tobacco — cat 5 

Baby — cat 5 

Moon — cat 5 

Scissors — cat 5 

Quiet — cat 5 

Green — cat 5 

Salt— cat 5 

Street — cat 5 

King— cat 5 

Cheese— cat 5 

Blossom — cat 5 

Afraid — cat 



Ocean — fresh 19 

Head— unhealthy 15 

Stove — warmth 

Long— length 

Religion — needed 2 

Whiskey ^needed 5 

Child— needed 

Bitter — needed 5 

Hammer — needed 5 

Thirsty — water 

City — pretty 6 

Square — honest 

Butter — good 1 

Doctor — needed 

Loud — needed 5 

Thief— trust 

Lion — love 19 

Joy — laughter 

Bed — comfortable 

Heavy — sleepiness 2 

Tobacco — needed 6 

Baby — needed 5 

Moon— needed 5 

Scissors — needed 5 

Quiet — pleasure 1 

Green — me 12 

Salt — needed 

Street — needed 5 

King — needed 5 

Cheese — needed 5 

Blossom — needed 5 

Afraid — ner\'ous 



338 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 2292. — C. M. Perseveration : numerous instances of associa- 
tion to preceding reaction; unclassified reactions, mostly incoherent. 



Table— tree 19 

Dark— night 

Music— instrument 

Sickness — smoke 19 

Man — woman 1 

Deep — water 

Soft— tide 18 

Eating— potato 

Mountain— milk 13 

House — clay 17 

Black— polish 17 

Mutton— goat 

Comfort — cream 10 

Hand— hay 19 

Short— meat 19 

Fruit — pears 

Butterfly — flower 

Smooth — smell 10 

Command— drink 19 

Chair — wine 18 

Sweet— honey 

"Whistle — wind 

Woman — whiskey 19 

Cold— fire 

Slow — speed 

Wish — go 

River — boat 

White— stem 13 

Beautiful— cloak 17 

Window— drift 19 

Rough — storm 

Citizen — citron 10 

Foot— feed 19 

Spider-web 



Needle — thread 

Red— sew 13 

Sleep — rest 

Anger — health 13 

Carpet— carrots 10 

Girl— eat 19 

High — horse 19 

Working— hay 15 

Sour — cut 19 

Earth— machine 19 

Trouble — repair 18 

Soldier — mow 19 

Cabbage — plant 

Hard— seed 18 

Eagle — bird 

Stomach — egg 17 

Stem — join 

Lamp — oil 

Dream — ^bum 13 

Yellow— gas 18 

Bread— flour 

Justice — drink 19 

Boy— girl 

Light — man 9 

Health — woman 1 

Bible— baby 10 

Memory — want 19 

Sheep — lamb 

Bath— water 

Cottage — hay 15 

Swift— corn 18 

Blue— eat 18 

Hungry— ham l7 

Priest— pickle 18 



Ocean — turnip 18 

Head — hair 

Stove — coal 

Long— wood 13 

Religion — lemon 10 

Whiskev — wheat 17 

Child— rye 18 

Bitter — medicine 

Hammer — nail 

Thirsty— beer 

City — cake 19 

Square — pie 18 

Butter — cream 

Doctor — herb 19 

Loud — duck 19 

Thief— feathers 18 

Lion — animal 

Joy — peace 

Bed — sleep 

Heavy — rest 13 

Tobacco — chew 

Baby — chair 19 

Moon — sun 

Scissors — cut 

Quiet— hair 18 

Green — grapes 

Salt— bag 19 

Street — stone 

King— cement 18 

Cheese — money 19 

Blossom — flower 

Afraid— fast 19 



Case No. 17880. — E. D. Numerous repetitions of reactions previously- 
given; unclassified reactions, mostly incoherent; neologisms. 

Ocean— help 6 

Head — knowing 2 

Stove — cooking 

Long— bank 19 

Religion — church 

WTiiekey — drink 

Child— help 6 

Bitter— error 10 

Hammer — builder 2 

Thirsty— drink 

City— building 

Square — unerrorer 4 

Butter— eating 

Doctor — destroyer 10 

Loud— notoriety 17 

Thief— error 15 

Lion — lord 19 

Joy — escorted ft 

Bed — unescorted 15 

Heavy — unescorted 5 

Tobacco — chewing 

Baby — help 6 

Moon — knowing 

Scissors — tailor 

Quiet — form 15 

Green — moneyed 19 

Salt — eating 

Street— city 

King— adds 19 

Cheese — eating 

Blossom — escorted 6 

Afraid — unguarded 15 



Table — eating 

Dark— night 

Music — piano 

Sickness— stoppery 4 

Man — manly 

Deep — knowing 6 

Sof t— undoable 4 

Eating — oblong 19 

Mountain — guide 19 

House — residing 2 

Black — dress 

Mutton — aiding 19 

Comfort — escorted 6 

Hand — escorted 5 

Short — unescorted 18 

Fruit — eating 

Butterfly—interfere 19 

Smooth— knowing 6 

Command— unerrorer ... 4 

Chair—seated 

Sweet— durable 19 

"Whistle— treated 19 

Woman — help 2 

Cold — stoppery 4 

Slow — unknowing 4 

Wish — treated 15 

River — boats 

White — treasurer 19 

Beautiful — form 

Window — outlook 

Rough — unescorted 15 

Citizen — residing 2 

Foot— travel 

Spider— stoppery 4 



Needle — clothing 2 

Red — color 

Sleep — stoppery 4 

Anger — unguarded 17 

Carpet — residence 15 

Girl— help 6 

High — escorted 6 

Working — man 1 

Sour — form 15 

Earth — platformer 4 

Trouble — unguarded ... .15 

Soldier— sentinel 2 

Cabbage — dinners 2 

Hard — escorted 6 

Eagle — newspaper 17 

Stomach— health 

Stem — winding 

Lamp — reading 

Dream — guarded 19 

Yellow — aged 19 

Bread — knowing 6 

Justice — bar 17 

Boy— help 6 

Light — advice 19 

Health— doableness 4 

Bible — church 

Memory— knowing 2 

Sheep— aided 15 

Bath — stoppery 4 

Cottage — seashore 

Swift — business 17 

Blue— help 6 

Hungrj' — unadded 4 

Priest — Rome 19 



I9IO] 



CRACE HELEN KENT AND A. J- ROSANOE. 



339 



_^. r. u.c,...i«.^ «"r:' ""*:.:■:';"«£ 



'=*■':* -^IZtl'^^oc'"'" to P~.di.g reaction 



severation 

stimulus. 

Table— etove 
Dark— tlear 
Music— calm 



Needle— pins •• 
Bed— person . . 
Sleep— nervous 



9 
.17 



bleep — uei*-^"", •■■- ,c- 

, ... Anger-determined 1* 

Sickness— exact • -^^ Carpet— floor •• ^ 



Man— particular 

Deep— personal 

Soft— (rank •■•;••• ,„ 

Eating-determined ...-la 

Mountain— idea 

House— street 

Black— water . 

Mutton— ground ■ 

Comfort— country J= 

Hand— Are . • • ■ .„ 

Short— straight •'" 

Fruit— flowers 

Butterfly— horn " 

Smooth— fann ■••■■••■■• „ 
Command— forbidden ..■ ^ 

Chair— bed 

Sweet— sugar 

Whistle-noise 

Woman— boy ,„ 

Cold— house ^ 

Slow— store . 

Wish— work ' 

River— sound '■' 

White— blue 

Beautiful— fair 

Window— door 

Bough— glass ' 

Citizen— dress ' 

Foot— exact '■' 

Spider— fly 



Girl— man 
High— fruit ... 
Working— wear 
Sour- sweet 



.19 
.10 



10 



.16 
. 9 



.14 



Earth— early .„ 

Trouble— state " 

Soldier— girl 

Cabbage— woman 

Hard— heart 

Eagle— bird ..•• .,„ 

Stomach— friend ^^ 

Stem— tree ..^ 

Lamp— couch ^^ 

Dream— desk 

Yellow— table . . 

Bread— chair 

Justice— truth ^^ 

Boy— honor „ 

Light— tails 

Health— care 

Bible— book ■■■■■■■■■■' 
Memory-remembrance. . .^^ 

Sheep— free .„ 

Bath— court .,„ 

Cottage— pitcher '^o 

Swift— strong „ 

Blue— delicate 

Hungry- bread 

Priest— church 



Ocean — ship „ 

Head- height J 

Stove— people „ 

Long— heart . • . • ■ 

Rcligion-Cathohc 

\S'hiskey-Brookl>-n i» 

Child-New York !» 

Bitter— frost . 

Hammer— summer i" 

Thirsty-fall J 

City— autumn 

Square— winter ^ 

Butter-daily ..- 

Doctor— midnight ^ 

Loud— forenoon '= 

Thief— afternoon i| 

Lion— evening ^° 

Jov— sorrow „ 

Bed— obstinate •• '• 

Heavv— indifferent " 

Tobacco— pipe 

Baby— mother 

Moon— daughter ^| 

Scissors— son g 

Quiet- sister 

Green-brother " 

Salt— forward . 

Street— proper * 

King-vulgar , 

Cheese— personal " 

Blossom— tree 

Afraid— tear 



.10 

.10 

19 



Case No. 
incoherent. 



Table— tablet 

Dark — dot . . 

Music— Lizzie ■ 

Sickness— Josh 

Man-McMahon J" 

Deep-deaf (deef) f 

Soft-sulphur 

Eating— itching J 

Mountain— mouth ™ 

House— horse . 

Black-back J 

Mutton— button ^X 

Comfort— community 

Hand— hat 

-shore 



17188.— G. B. Sound reactions 



unclassified reactions, 



mostly 



.10 
10 
10 



Needle— shoe 

Red— book 

Sleep— sifting 

Anger— Freeman . • 

Carpet— longing . . . 

Girl— gone 

High— law ..■ 

Working— back 

Sour— clock 

Earth— flower ..■•■ 
Trouble— sensibility 



.19 



.19 
.19 
.19 
,.19 
..19 
..15 
..19 



.13 

.19 
.19 



...17 



Soldier' 
Cabbage— Cabot 
Hard— done 



sodder J" 



Short— »""'= ■• ,n 

—Freehoff 1^ 

1 

10 
10 



Fruit- 

Butterfly— busty 

Smooth-small ••■.••••• 
Command-Cummmgs 

Chair— cherries "' 

Sweet— sweeten J? 

Whistle-Walters '« 

Woman— waj-man ^" 

Cold-laboratory " 

Slow— slaw ' 

Wish— wishbone 

River- Ontario " 

White— William '^ 

Beautiful-bureau i" 

Window— Weldon "' 

Eough-eaw ^ 

Citizen— Sendow i' 

Foot— hoof 

Spider— web 



F.aglf^-tlme 

Stomach— mat " 

Stem— water 

Lami)— florist ^ 

Dream— Conners " 

Yellow— flower 

Bread— water 

Justicf^Gaynor " 

Boy — passion ^^ 

Light-life 

Health— wealth 

Bible— gone ^■i 

Memory— Hans '^■' 

Sheep— pasture 

Bath— Rogan " 

Cottage-house 

Swift— swim !:^ 

Blue— Thompson i' 

Hungry-memory i| 

Priest— golden •■° 



Ocean— hat 

Head— broom 

Stove— fan 

Long-time 

Religion-Yukon "> 

Whiskey— Freeman 1^ 

Child-Hopkins " 

Bitter— brown 

Hammer— hands :J" 

Thirsty— thirty i 

City— sure .„ 

Ir^r^ro'Shaniei-.-.lO 

Doctor— Dorsan '^ 

Loud— law ,„ 

Thief— child ^^ 

Lion — dirty . 

Jov— commerce J" 

Bed— strike .„ 

Heavy-Walden " 

Tobacco— .Mice f^ 

Baby— water 

Moon— handsome ^ 

Scissors— comet 

Quiet— tiger " 

Green— tree 

Salt— salary ^„ 

Street- prunes ^^ 

King— kind ••••■■ ,5 

Cheese — handsome '^ 

Blossom— pretty 

Afraid-Africa »" 



340 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 6238.— M. H. Sound reactions; unclassified reactions, mostly 
incoherent. 



Table— token 19 

Dark — dye 17 

Music — meat 10 

Sickness — sorrow 

Man— mother 17 

Deep — dark 

Soft— silk 

Eating — elephant 19 

Mountain — many 10 

House — home 

Black — brown 

Mutton — men 10 

Comfort— cat 10 

Hand— hat 10 

Short— shift 10 

Fruit— free 10 

Butterfly— baby 19 

Smooth— 8oft 

Command — cat 10 

Chair — comfort 

Sweet— sugar 

Whistle — wine 19 

Woman — when 10 

Cold— cat 15 

Slo\v — short 

W'ish — when 13 

River — Rhine 

White— when 10 

Beautiful — baby 

Window — wide 

Rough — red 10 

Citizen — company 19 

Foot — feeling 19 

Spider — speck 10 



Needle — nothinf? IS 

Red— rose 

Sleep— should 12 

Anger— after 10 

Carpet — cat 10 

Girl— God 19 

1 1 igh — heaven 

Working — will 2 

Sour— sweet 

Karth — eaten 14 

Trouble— tea 10 

Soldier — sailor 

Cabbage— cobweb 19 

Hard — haven't 12 

Eagle — eaten 15 

Stomach — sat 10 

Stem— should 12 

Lamp— little 19 

Dream — did 12 

Yellow — you 10 

Bread — butter 

Justice — Jesus 10 

Boy — baby 

Light— love 14 

Health — heaven 

Bible— bitch 19 

Memory — man 1 

Sheep — shepherd 

Bath— both 10 

Cottage— cat 10 

Swift— said 19 

Blue— bad 9 

Himgry— haven't 12 

Priest— Pope 



Ocean — open 10 

Head — heart 

Stove — steel 

Long— little 15 

Religion — right 

Whiskey — when 12 

Child — chimnev 19 

Bitter— both ." 19 

Hammer—heart 15 

Thirstv— think 9 

City— church 17 

Square — swift 19 

Butter — bread 

Doctor— debtor 10 

Loud— loaf 19 

Thief— theatre 10 

Lion — liar 10 

Joy— jam 19 

Bed— broom 19 

Heavy— hard 

Tobacco— Tom 19 

Babv— brother 17 

Moon — men 2 

Scissors — shift 10 

Quiet— quilt 10 

Green — grass 

Salt— said 19 

Street— Stevens 10 

King—kite 19 

Cheese — cat 15 

Blossom— bad 9 

Afraid — anger 



Case No. 12720. — J. B. Unclassified reactions, many of which are prob- 
ably due to distraction ; some stereotypy. Note on test record states : " In- 
fluenced by sensory impressions, but gave good attention to each stimulus 
word. Had some difficulty in limiting his response to one word, but made 
all possible effort to comply with every request. On one occasion he was 
asked to react with his eyes closed, but was unable, under the unnatural 
conditions, to respond with one word." 



Table — floor 

Dark— light 

Music — shoe 19 

Sickness — well 

Man — boy 

Deep — sea 

Soft — soap 

Eatintj — tea 17 

Mountain — forest 17 

House — horse 10 

Black— sill 19 

Mutton— tablecloth 17 

Comfort- black 16 

Hand — fingers 

Short— wrist 13 

Fruit — soup 17 

Butterfly— grape 13 

Smooth — coat 

Command— vest 18 

Chair — pillow 19 

Sweet— brick 19 

Whistle— knuckles 19 

Woman — wall i9 

Cold— eating 19 

Slow— swift 

Wish— knob 19 

River— pad 19 

White— book ., 19 

Beautiful — shad<iw B 

Window — fltockings 19 

Rough — stand 1^' 

Citizen — blue 19 

Foot — brass 19 

Spider— shoelace 19 



Needle — name 19 

Red— sunlight 19 

Sleep— flag 13 

Anger — slant 19 

Carpet— rip 19 

Girl- lady 

High — stripe 19 

Working — steam 17 

Sour — handkerchief 19 

Earth — ground 

Trouble — insect 19 

Soldier — army 

Cabbage — sill 15 

Hard — washstand 19 

Eagle — blue 15 

Stomach— tap 10 

Stem— sill 15 

Lamp— back 19 

Dream — shadow 2 

Yellow— blanket 19 

Bread — horizontal 19 

Justice — ink 19 

Boy— taste 19 

Light — yellow 

Health— book 19 

Bible— Joseph 17 

Memory — Joe 18 

Sheep — pillow 19 

Bath— Mott 19 

Cottage — globe 19 

Swift— continue 19 

Blue — notice 19 

Hungr>'— Josephine 19 

Priest— sixteen 12 



Ocean — flag 15 

Head — cabbage 

Stove — rivet 17 

Long — floor 19 

Rel igion — priest 

Whiskey— tin 19 

Child— shadow 6 

Bitter— black 15 

Hammer — buttons 15 

Thirstv — shadow 

City— back 15 

Square — oval 

Butter— table 

Doctor — doorway 10 

Loud — shadow 6 

Thief— butter 16 

Lion — difference 19 

Joy — ink 15 

Bed— butter 15 

Heavj' — shadow 6 

Tobacco — wood 13 

Baby— wall 15 

Moon— lightning 17 

Scissors — book 15 

Ouiet— yellow 15 

Green — sole 19 

Salt— ink 15 

Street— sides 19 

King — stripes 19 

Cheese — butter 

Blossom — trees 

Afraid — boy 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



341 



Case No. 5374.— J. F. Perseveration; some stereotypy; sound reactions; 
unclassified reactions many of which are probably due to distraction. Note 
on test record states: "Understood what was expected, but could not be 
induced to give much attention to the stimulus words ; sat facing a window, 
and showed a strong tendency to merely name objects in sight. Reaction 
time very short, in some cases so short that it is doubtful if he recognized 
the stimulus word at all." 

Needle — pin 

Red — cushion 18 

Sleep— black 13 

Anger — white 14 

Carpet— vingency 4 

Girl— noodles 19 

High — macaroni 18 

Working—tomatoes 18 

Sour— asparagus 18 

Earth— oakry 4 

Trouble— peas 19 

Soldier — beans 18 

Cabbage — greens 

Hard — cow 19 

Eagle — robin 

Stomach — hawk 13 

Stem— fishes 19 

Lamp — whale IS 

Dream — shark 18 

Yellow — crabs IS 

Bread— red 10 

Justice — jam 19 

Boy— be 2 

Light— girl 13 

Health— filth 10 

Bible — ^book 

Memorj'— bad 1 

Sheep— dat 4 

Bath— oval 19 

Cottage — nurse 19 

Swift— begin 19 

Blue— joy 19 

Hungry — wonder 10 

Priest— apostle 17 

Sound reactions; particles; unclassified reactions, 



Table— God 19 

Dark— angel 18 

Music — bird 

Sickness — woman 9 

Man — male 

Deep — dove 19 

Soft— dog 19 

Eating— horse 18 

Mountain — mule 18 

House — dog 

Black— rabbit 18 

Mutton— hen IS 

Comfort — dog 15 

Hand — clock 

Short— mvsell 

Fruit— post 19 

Butterfly— bricks 19 

Smooth— glass 

Command — sand 10 

Chair— leaf 19 

Sweet — wood 19 

\Vhistle— earth 19 

Woman — grass 14 

Cold— mustard 19 

Slow— kale 19 

Wish- lampsquob 4 

River— ten 12 

White— rock 17 

Beautiful— water 17 

Window — scene 

Rough — been 12 

Citizen — house 13 

Foot— stable 2 

Spider — horse 13 

Case No. 1431. — A. L. 

mostly incoherent. 

Table — ammitting 4 

Dark — cat 

Music— hello 12 

Sickness— spelling 19 

Man— then 12 

Deep — heap 10 

Soft— deep 7 

Eating— people 1 

Mountain — striking 19 

House — pat 19 

Black— and 12 

Mutton— it 12 

Comfort— herself 12 

Hand— self 19 

Short— length 

Fruit— long 13 

Butterfly— quick 19 

Smooth — edges 19 

Command — first 17 

Chair — exact 19 

Sweet — nicest 2 

Whistle— thistle 10 

Woman — pins 19 

Cold — waving 19 

Slow— swift 

Wiah- choice 17 

River— never 10 

^Vhite— black 

Beautiful— much 19 

Window — such 19 

Rough — exact 15 

Citizen — just 

Foot— root 10 

Spider — diving 19 

23 



Ocean — preacher 13 

Head— dead 10 

Stove — store 10 

Long— lone 10 

Religion— world 19 

Whiskey — whisper 10 

Child— gule 4 

Bitter— Rugby 19 

Hammer— ball 18 

Thirsty— sun 19 

City— Christ 10 

Square — Jesus 18 

Butter— Joe 19 

Doctor — John 17 

Loud — Luke 18 

Thief— St. Matthew 18 

Lion — lie 10 

Jov — George 10 

Bed— Beth 10 

Heavy — tither 4 

Tobacco — iron 13 

Baby— blade 10 

Moon — stars 

Scissors — sun 13 

Quiet — wired 10 

Green — mean 10 

Salt— Lou 19 

Street— vault 19 

King — sepulchre 18 

Cheese — Presbyterian . . .19 

Blossom— Baptist 18 

Afraid— Methodist 18 



Needle — Hercules 19 

Red— green 

Sleep— deep 

Anger— grief 

Carpet — cheap 19 

Girl— ink 19 

High— I 10 

Working— loafing 

Sour— hour 10 

Earth— hurt 10 

Trouble— bubble 10 

Soldier— yes 12 

Cabbage — garbage 10 

Hard— hitting 17 

Eagle— fitting 19 

Stomach- pitting 19 

Stem — condemned 10 

Lamp — stamp 10 

Dream — stained 19 

Yellow — purple 

Bread— pimple 19 

Justice — suit 17 

Boy — ahoy 12 

Light— night 

Health— wealth 

Bible — indeed 12 

Memory — remembering . . 

Sheep — cow 

Bath— sponge 

Cottage — people 1 

Swift— left 10 

Blue— shift 19 

Hungry— property 19 

Priest— judge 2 



Ocean — river 

Head— sea 13 

Stove— Venus 19 

Long — hog 19 

Religion— pigeon 10 

■WTiiskev- gin 

Child— thing 19 

Bitter— better 10 

Hammer — happy 9 

Thirstv— wbiskev 17 

City— fitting 10 

Square — round 

Butter— shut 10 

Doctor — exercise 19 

Loud — accounts 10 

Thief— endless 19 

Lion — tiger 

Joy— fast 19 

Bed— grass 19 

Hea\-y— heaving 10 

Tobacco— queen 19 

Biby— water 19 

Moon — room 19 

Scissors — pants 17 

Quiet — razor 13 

Green — steel 18 

Salt — sharp 

Street— fence 19 

King — bring 10 

Cheese — eggs 

Blossom — see 19 

Afraid — awaiting 19 



342 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 6251. — C. D. Some stereotypy; particles ; unclassified re- 
actions, mostly incoherent. 



Table— doctor 19 

Dark— nigger 17 

Music — violin 

Sickness — whores 19 

Man — Mulcane 17 

Deep— deaf 19 

Soft— hearing IS 

Eating— pillow 13 

Mountain— sight 19 

House — pure 19 

Black— nigger 

Mutton— plenty 6 

Comfort — middle 19 

Hand— left 17 

Short— one 12 

Fruit— up 12 

Butterfly— bird 

Smooth— never 6 

Command — commodore ..10 

Chair— seat 

Sweet — sugar 

Whistle— highest 19 

Woman — Constance 17 

Cold— temperature 

Slow — walk 

Wish — wishbone 

River— love 19 

WTiite— Dr. AVhite 17 

Beautiful— pretty 1 

Window — dove 19 

Rough — fine 1 

Citizen— United States. . 

Foot— left 15 

Spider— web 



Needle — ether 19 

Red — pot 

Sleep — wake 

Anger— mad 

Carpet— pretty 1 

Girl — boy 

High— Heidel 10 

Working — never 

Sour — sweet 

Earth— bride 19 

Trouble — mischief 

Soldier — war 

Cabbage — head 

Hard — never 6 

Eagle— fly 

Stomach — go 19 

Stem— study 10 

Lamp — light 

Dream — behave 19 

Yellow — false 19 

Bread — plenty 6 

Justice — ^just 

Boy — come 19 

Light— Davie 19 

Health— wealth 

Bible — Constance 15 

Memory — fine 1 

Sheep — plenty 6 

Bath— bother 10 

Cottage — mansion 

Swift— hurry 

Blue — flowers 2 

Hungry — never 

Priest — highest 2 



Ocean — land 

Head — millionaire 19 

Stove — twenty-five 12 

Long— thirty -four 12 

Religon — churches 

Wh is kev— plenty 6 

Child— baby 

Bitter — sorrow 

Hammer — court 19 

Thirstv— blood 11 

City— this 12 

Square — I 12 

Butter— plenty 6 

Doctor—millionaire ... .15 

Loud— tell 17 

Thief— rich 19 

Lion— west 19 

Joy — ever 12 

Bed — Constance 15 

Heavy — fine 9 

Tobacco — back 10 

Baby— millionaire 15 

Moon — always 12 

Scissors — large 9 

Quiet— stay 19 

Green — flowers 

Salt— perfume 18 

Street— floor 19 

King— Haaken 19 

Cheese — kiss 19 

Blossom — flower 

Afraid — never 



Case No. 17607. — P. D. Test record somewhat approaching the normal : 
24 individual reactions, of which 16 are unclassified, mostly " far fetched " 
and not strictly incoherent. Patient is a well-marked case of dementia 
prjecox but only moderately deteriorated; works well at the hospital. 



Table— oak 

Dark — brown 

Music — falsetto 17 

Sickness — typhoid 

Man — gender 19 

Deep— feet 19 

Soft — feeling 

Eating— partaking 19 

Mountain — hunter 19 

House — dwelling 

Black — color 

Mutton — sheep 

Comfort — cozinesa 2 

Hand— anatomy 

Short — stature 

Fruit— apples 

Butterfly— insect 

Smooth — plain 

Command — order 

Chair— furniture 

Sweet — sugar 

^Vh^stle — steam 

Woman — sex 

Cold — degree 

Slow — speedless 

Wish— expression 

River — Amazon 

White— pulp 17 

Beautiful — description . . 

Window — opaque 19 

Rough— uncouth 

Citi2en — qualification . . .19 

Foot — anatomy 

Spider — bug 



Needle — steel 

Red — color 

Sleep — slumber 

Anger — aroused 

Carpet— texture 2 

Girl— female 

High— up 

Working — doing 

Sour — lemon 

Earth— dirt 

Trouble — distress 

Soldier — uniform 

Cabbage — crop 19 

Hard — metal 

Eagle — bird 

Stomach— anatomy 

Stem— pipe 

Lamp — glass 

Dream — atmosphere 19 

Yellow — color 

Bread— flour 

Justice — equality 

Boy — male 

Light — sun 

Health — color 

Bible — nonsense 19 

Memory — retentiveness . . 2 

Sheep — quadruped 

Bath — water 

Cottage — stories 19 

Swift— speed 

Blue — navy 

Hungry — appetite 

Priest — uniform 15 



Ocean — Atlantic 

Head — stature 15 

Stove — iron 

Long — inches 17 

Religion — creed 

Whiskey — hops 

Child— neuter 19 

Bitter — horehound 17 

Hammer — steel 

Thirsty — degree 15 

City— population 

Square — sides 

Butter — cream 

Doctor — physician 

Loud — noise 

Thief — characterization . . 19 

Lion — menagerie 

Joy — openness 19 

Bed — furnittire 

Heavy— weight 

Tobacco — plant 

Baby— egg 19 

Moon — astronomy 

Scissors — blades 

Quiet — noiseless 

Green — Paris 11 

Salt— crystal 17 

Street— lane 

King— usurper 19 

Cheese — milk 

Blossom — bud 

Afraid — scared 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



343 



Case No. 5537. — J. H. Test record approaching the normal: 21 indi- 
vidual reactions, 8 classed as normal, i non-specific, 12 unclassified, mostly 
" far fetched " but not strictly incoherent. Well-marked dementia praecox, 
but of recent origin and but slight deterioration. 



Table— eat 

Dark — night 

Music — pleasure 1 

Sickness — suffering 

Man — farmer 17 

Deep — low 

Soft— hard 

Eating— life 

Mountain — earth 

House — dwelling 

Black — color 

Mutton — food 

Comfort — rest 

Hand — limb 

Short — small 1 

Fruit — nourishing 

Butterfly— flower 

Smooth — straight 

Command — obey 

Chair — furniture 

Sweet — palate 2 

Whistle — noise 

Woman — marriage 

Cold — indisposed 17 

Slow — weary 19 

Wish — work 9 

River — tug 

White — sheets 2 

Beautiful — rare 19 

Window— ventilation .... 

Rough — uneven 

Citizen— public 17 

Foot — walk 

Spider-web 



Needle — sew 

Red — marine 19 

Sleep — repose 

Anger— assault 17 

Carpet — cloth 

Girl — sister 

High — above 

Working — labor 

Sour — bitter 

Earth — farm 

Trouble— fight 

Soldier — duty 

Cabbage — vegetable 

Hard— stone 

Eagle— large 1 

Stomach — body 

Stem — leaf 

Lamp — light 

Dream — unconsciousness. . 

Yellow — flag 

Bread — hunger 

Justice — freedom 

Boy — school 

Light — electricity 

Health — business 19 

Bible — religion 

Memory— brain 

Sheep — pasture 

Bath — clean 

Cottage — property 17 

Swift — current 

Blue — uniform 17 

Hungry — appetite 

Priest — church 



Ocean — commerce 19 

Head— thought 1 

Stove — iron 

Long — dstance 

Religion — belief 

Whiskey — alcohol 

Child — parent .... 

Bitter — taste 

Hammer— trade 19 

Thirsty — beverage 

City — position 19 

Square — block 

Butter — yellow 

Doctor— profession 

Loud— fiddle 17 

Thief— police 

Lion — Africa 

Joy — sensation 

Bed— rest 

Heavy — burden 

Tobacco — store 19 

Baby — care 

Moon — atmosphere 

Scissors — dressmaker 

Quiet — lonesome 

Green — color 

Salt— house 19 

Street — neighborhood . . .17 

King— beast 19 

Cheese — merchant 19 

Blossom — flowers 

Afraid— train 10 



Case No. 6190. — L. L. Test record not distinguishable from normal. 
Case of recent onset, with little, if any deterioration. 

Ocean — ships 

Head — mind 

Stove — chimney 

Long — wind 19 

Religion — God 

Whiskey— alcohol 

Child — mother 

Bitter — fruit ... 

Hammer — naila 

Thirsty — water i . . . 

City — cars 

Square — angles 

Butter — cow 

Doctor — sickness 

Loud— noise 

Thief — sinner 2 

Lion — jungle 

Joy — gladness 

Bed— pillow 

Heavy — iron 

Tobacco — leaf 

Baby — mother 

Moon — stars 

Scissors — thread 

Quiet — room 

Green — grass 

Salt — ocean 

Street— men 15 

King — queen 

Cheese — butter 

Blossom — bud 

Afraid — coward 



Table — chair 

Dark— light 

Music — note 

Sickness — health 

Man — woman 1 

Deep — shallow 

Soft— hard 

Eating— breakfast 

Mountain — rock 

House — chimney 

Black— white 

Mutton — animal 

Comfort — chair 

Hand — foot 

Short- long 

Fruit — ripe 

Butterfly— fields 

Smooth — hard 

Command — army 

Chair — straw 19 

Sweet— bitter 

Whistle — engine 

Woman — man 1 

Cold— hot 

Slow — fast 

Wish — desire 

River — brook 

White— black 

Beautiful"p:irl 

Window — glass 

RoTigh— smooth 

Citizen — city 

Foot — ankle 

Spider — web 



Needle — cotton 

Red— brick 

Sleep — night 

Anger — joy 

Carpet — cloth 

Girl— mouth 17 

High — low 

Working— idle 

Sour — vinegar 

Earth— round 

Trouble — sickness 

Soldier— gun 

Cabbage — garden 

Hard — rock 

Eagle— fly 

Stomach — man 1 

Stem — watch 

Lamp — oil 

Dream — sleep 

Yellow — sunflower 

Bread — butter 

Justice — peace 

Boy — grirl 

Light — window 

Health— man 1 

Bible— God 

Memory— mind 

Sheep — pastiire 

Bath — water 

Cottage — trees 

Swift — engine 

Blue — sky 

Hungry' — bread 

Priest — church 



344 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 1278. — B. B. Test record not distinguishable from normal. 
Case of several years standing, but showing almost complete remission of 
all symptoms. 



Table — chair 

Dark — day 

Music — instrument 

Sickness— health 

Man — woman 1 

Deep — thoughts 1 

Soft— apple 

Eating — food 

Mountain — rock 

House — building 

Black — dark 

Mutton — meat 

Comfort — home 

Hand — from 12 

Short — stout 

Fruit — eating 

Butterfly— bird 

Smooth — glossy 

Command— general 

Chair— floor 

Sweet— taste 

Whistle — tune 

Woman — man 1 

Cold— chilly 

Slow — fast 

Wish — something 

River — water 

White— black 

Beautiful— pretty 1 

Window — pane 

Rough— ugly 

Citizen — papers 

Foot — shoe 

Spider — bug 



Needle — thread 

Red— white 

Sleep — slumber 

Anger — kindness 

Carpet— mat 

Girl — boy 

High — short 

Working— idle 

Sour — sweet 

Earth— land 

Trouble — sorrow 

Soldier — hero 

Cabbage — turnip 

Hard — soft 

Eagle — owl 

Stomach — head 

Stem — pipe 

Lamp — cover 19 

Dream — sleep 

Yellow — brown 

Bread— biscuit 

Justice — peaceful 2 

Boy — girl 

Light— dark 

Health— well 

Bible— book 

Memory — lost 2 

Sheep — animal 

Bath — wash 

Cottage — house 

Swift — movements 2 

Blue — red 

Hungry— thirst 

Priest— minister 



Ocean— sea 

Head— body 

Stove — iron 

Long— length 

Religion — too 12 

Whiskey — drink 

Child— baby 

Bitter — taste 

Hammer— nails 

Thirsty— drink 

City — town 

Square — man 1 

Butter — bread 

Doctor — patient 

Loud — howl 17 

Thief— fiteal 

Lion — bear 

Jov — happiness 1 

Bed— blanket 

Heavy — weight 

Tobacco— smoke 

Baby — cradle 

Moon — sun 

Scissors — thimble 

Quiet — stillness 

Green — plaid 17 

Salt — pepper 

Street— sidewalk 

King — queen 

Cheese — crackers 

Blossom — leaf ... 

Afraid— frightened 



PARANOIC CONDITIONS. 

The clinical group of psychoses included under the designation 
paranoic conditions is far from being homogeneous. We have here 
cases that are more or less closely allied to the paranoid form of 
dementia prascox, other cases that are apparently dependent upon 
involutional changes (Kraepelin's pracscnilcr Beeintrachtii^ujigs- 
wahn), still other cases that are characterized by absence or at 
least delay of mental deterioration, etc. 

In some of these cases disturbance of the flov^ of utterance is 
not observed, and the test records obtained from them present 
no striking abnormalities. Distinctly pathological records are 
obtained mainly from those cases which clinically resemble de- 
mentia prsecox; in these records the nature of the pathological 
reactions would seem to indicate that the diagnosis of dementia 
prsecox would be more justifiable than that of paranoic condition. 

The following test records will serve to illustrate the types of 
reactions met with in this group of psychoses : 



ipio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



345 



Case No. 3039. — F. A. Normal record. 



Table — purpose 19 

Dark — obscure 

Music — pleasant 1 

Sickness — confinement . .17 

Man— twenty-one 12 

Deep— down 

Soft — smooth 

Katinp— nourishment . . . 

Mountain — high 

House — living 

Black — dark 

Mutton — eating 

Comfort — pleasant 1 

Hand — limb 

Short — low 

Fruit — eat 

Butterfly— miller 

Smooth — soft 

Command — obey 

Chair— sitting 

Sweet — tasting 

Whistle — noise 

Woman— female 

Cold — unpleasant 1 

Slow — easy 

Wish — want 

River — water 

White — colorless 

Beautiful— handsome . . . 

Window— glasB 

Rough— unpleasant 1 

Citizen — vote 

Foot— limb 

Spider — inflect 



Needle — sewing 

Red — color 

Sleep — bed 

Anger — cross 

Carpet— floor 

Girl— young 

High — up 

Working— labor 

Sour— unpleasant 1 

Earth— dirt 

Trouble — worriment 

Soldier— fight 

Cabbage — vegetable 

Hard— tough 

Eagle — bird 

Stomach— anatomy 

Stem— growth 

Lamp — burn 

Dream — restlessness 

Yellow — color 

Bread — eat 

Justice — right 

Boy — young 

Light — see 

Health— well 

Bible — religion 

Memory — thoughtful .... 

Sheep — animal 

Bath— wash 

Cottage — house 

Swift— fast 

Blue — color 

Hungry— appetite 

Priest— Christian 17 



Ocean — large 1 

Head— trunk 

Stove — fire 

Long — distance 

Religion — Christianity . . 

Whiskey — drinkable 

Child— young 

Bitter— bad 1 

Hammer — knock 

Thirsty — dry 

City — government 

Square — block 

Butter — eat 

Doctor — cure 

Loud — noisy 

Thief— steal 

Lion — animal 

Joy— pleasant 1 

Bed— laying 2 

Heavy — weighty 

Tobacco — smoking 

Baby — new-bom 17 

Moon— planet 

Scissors — cutting 

Quiet — easy 

Green— color 

Salt — preservative 2 

Street — lane 

King — monarch 

Cheese — eatable 

Blossom — budding 2 

Afraid — fear 



Case No. 5803. — D. E. D. Slight tendency to give sound reactions. 



Table— tree 19 

Dark— bright 

Music — song 

Sickness — health 

Man — woman 1 

Deep — shallow 

Soft— hard 

Eating — digesting 

Mountain — hill 

House — horse 10 

Black— red 

Mutton — tallow 

Comfort— wealth 

Hand — arm 

Short- long 

Fruit— plate 17 

Butterfly— net 

Smooth — surface 

Command— obey 

Chair — table 

Sweet — souT 

Whistle— call 

Woman— lady 

Cold — lukewarm 19 

Slow— not 12 

Wish — receive 

River- lake 

White— black 

Beautiful— graceful 

Window — door 

Rough — smooth 

Citizen — city 

Foot— leg 

Spider— soap 10 



Needle — pin 

Red— yellow 

Sleep — slumber 

Anger— amiable 

Carpet— mat 

Girl— bov 

High— hill 

Working— playing 

Sour — sweet 

Earth— land 

Trouble— tranquillity . . .10 

Soldier — boy 

Cabbage — plant 

Hard — easy 

Eagle— bird 

Stomach— bowels 

Stem — head 

Lamp — chimney 

Dream — mj-th 17 

Yellow — blue 

Bread — biscuit 

Justice — balance 17 

Boy — girl 

Light— gray 17 

Health — wealth 

Bible — prayerbook 

Memory— understanding. . 

Sheep — lamb 

Bath — swim 

Cottage — house 

Swift— slow 

Blue — yellow 

Hungry— €at 

Priest — bishop 



Ocean — river 

Head— neck 

. Stove — covers 2 

Long — short 

Religion — optional 19 

Whiskey — wine 

Child— baby 

Bitter— sweet 

Hammer — gimlet 17 

Thirsty — drink 

City — town 

Square — compass 

Butter— butterfly 10 

Doctor — lawyer 

Loud— lord 10 

Thief— beggar 

Lion — lioness 

Joy — sorrow 

Bed — couch 

Heavy — light 

Tobacco — cigarette 

Baby — child 

Moon — stars 

Scissors — knife 

Quiet— quilt 10 

Green — envy 

Salt — sewing 19 

Street— lane 

King — queen 

Cheese — cracker 

Blossom— flower 

Airaid — courageous 



346 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 2133. — M. F. 
incoherent ; perseveration. 

Table — eat 

Dark — niffht 

Music — eing 

Sickness— sadness 

Man — home 

Deep — lifiht 

Soft— Bleep 13 

Eating— drink 

Mountain— hills 

House — home 

Black— stove 17 

Mutton— lamb 

Comfort- pleasure 1 

Hand — write 

Short— short-cake 10 

Fruit — grapes 

Butterfly— butter 

Smooth— ironing 

Command — correct 19 

Chair— see 19 

Sweet— apples 

"Whistle — happiness 1 

Woman — girl 

Cold — warm 

Slow — fast 

Wish— like 

River — water 

White— blue 

Beautiful— red 13 

Window — light 

Rough — easy 

Citizen — spring 19 

Foot— run 

Spider— fly 

Case No. 4569.— L. K. 
incoherent 

Table— fruit 17 

Dark— light 

Music— pleasure 1 

Sickness — illness 

Man — parent 8 

Deep — verse 19 

Soft— fruit 

Eating— illness 15 

Mountain — parent 6 

House — privilege 19 

Black— colors 2 

Mutton — parent 6 

Comfort— family 18 

Hand— comfort 7 

Short- parent 6 

Fruit — parent 5 

Butterfly — insect 

Smooth— surface 

Command — privilege .... 15 

Chair— house 

Sweet — dairy 19 

Whistle— nature 19 

Woman— parent 6 

Cold — house 6 

Slow— light 15 

Wish — desire 

River — house 6 

White — suspicion 19 

Beautiful— house 6 

Window— light 

Rough — surface 

Citizen— parent 6 

Foot— house 

Spider— insect 



Unclassified reactions, mostly " far fetched " or 



Needle— Carrie 19 

Red— pink 

Sleep — awake 

Anger— jolly 19 

Carpet — curtains 

Giri— yellow 19 

High— green 14 

Working— bed 19 

Sour— dishes 19 

Earth- grapes 13 

Trouble — work 1 

Soldier— sing 15 

Cabbage — potatoes 

Hard — sewing 17 

Eagle — daisy 19 

Stomach— flowers 18 

Stem—vine 

Lamp— fiatiron 19 

Dream — sleep 

Yellow — awake 13 

Bread- children 

Justice — dresses li 

Boy— mother 

Light— dark 

Health— wealth 

Bible — commands 2 

Memory— black 13 

Sheep — chickens 17 

Bath— carpet 19 

Cottage — worsted 14 

Swift— silk 18 

Blue— cotton 18 

Hungry — chair 19 

Priest — church 



Ocean— spring 15 

Head — canary 19 

Stove — board 

Long— dishes 13 

Religion— piano 19 

Whiskey— home 15 

Child— baby 

Bitter — shoes 19 

Hammer — tacks 

TTiirsty- longing 

City— Flushing 17 

Square — store 10 

Butter— butcher 10 

Doctor— hat 19 

Loud — chair 15 

Thief— picture 19 

Lion — house 13 

Joy — gladness 

Bed — sleep 

Heavy — sick 2 

Tobacco — album 19 

Baby— basket 17 

Moon— stars 

Scissors — knife 

Quiet — spoon 18 

Green — scar 19 

Salt — pepper 

Street — sugar 13 

King — blacking 19 

Cheese — meat 

Blossom — flowers 

Alraid— red 13 



Marked stereotypy; unclassified reactions, mostly 



Needle — house 6 

Red — colors 

Sleep— God 6 

Anger— God 5 

Carpet — house 

Girl— God 6 

High — house 

Working— parent 6 

Sour — desire 15 

Earth— God 6 

Trouble— God 5 

Soldier — house 6 

Cabbage — desire 15 

Hard — vegetable 

Eagle — animal 

Stomach — doctor 

Stem— growth 

Lamp — house 

Dream— God 6 

Yellow — color 

Bread- God 6 

Just ice — fright 19 

Boy — parent 6 

Light— God 6 

Health— God 5 

Bible — teachings 

Mem orv— teaching 2 

Sheep— God 6 

Bath— cleanness 

Cottage — home 

Swift— fear 19 

Blue — color 

Hungry — appetite 

Priest— servant 



Ocean — God 6 

Head— servant 6 

Stove — house 

Long — God 6 

Religion — servant 6 

Whiskey — doctor 15 

Child— house 6 

Bitter — taste 

Hammer— household 19 

Thirsty — drink 

City— God 6 

Square — touch 19 

Butter — taste 

Doctor — servant G 

Loud— thought 9 

Thief —slave 19 

Lion — animal 

Joy— pleasure 1 

Bed — household 16 

Heavy— weight 

Tobacco — doctor 15 

Baby — care 

Moon — heavens 

Scissors — household 15 

Quiet — nerve 19 

Green— substance 19 

Salt— taste 

Street— heavens 15 

King — servant 6 

Cheese — taste 

Blossom — sight 19 

Afraid — fear 



IQIOj 



GRACE HELEN KENT AND A. J. ROSANOFF 



347 



Case No. 6164. — L. E. Remarkably persistent tendency to give sound 
reactions; numerous sound neologisms; no reactions given in response to 
some of the stimulus words on the ground that she had *' no word to 
match." 



Table— wit chhazel 10 

Dark— frog 19 

Music — lessons 2 

Sickness— badness 2 

Man — wife 

Deep — seef 4 

Soft— shoft 3 

Eating:— feeding 

Mountain— sounding .... 10 

House— shmoufle 3 

Black— fake 19 

Mutton — shutton 3 

Comfort— aom fort 3 

Hand— land 10 

Short— court 10 

Fruit — shrewd 10 

Butterfly— shuddergy ... 3 

Smooth — slude 3 

Command — noman 3 

Chair— sash 19 

Sweet— leaf 19 

Whistle — noshissel 3 

Woman — lemon 19 

Cold— shoal 10 

Slow — snow 10 

Wish— dish 

River— liberty 10 

White — size 10 

Beautiful — 

Window— Hilda 19 

Rough— shoff 3 

Citizen — shifflzen 3 

Foot— shoot 10 

Spider— shider 3 



Needle — dreedle 3 

Red— shred 10 

Sleep — seef 3 

Anger — 

Carpet— shloppet 3 

Girl— shirl 3 

High— flp 10 

Working — shlirking 3 

Sour— bower 10 

Earth — world 

Trouble— shuttle 19 

Soldier — polster 3 

Cabbage — shefBes 4 

Hard — shward 3 

Eagle— 

Stomach— 

Stem— lamp 19 

Lamp — sant 4 

Dream- leam 3 

Yellow — cherry 19 

Bread— dread 10 

Justice — chestnuts 10 

Boy— 

Light — shwife 3 

Health— felt 2 

Bible— 

Memory— 

Sheep — sheet 10 

Bath— scab 19 

Cottage— foppach 3 

Swift— shift 10 

Blue— shoe 10 

Hungry— angry 

Priest— sheaf 19 



Ocean— notion 10 

Head— shred 10 

Stove — shove 3 

Long— song 10 

Religion— switching 19 

Whiskey — chiston 4 

Child— kile 3 

Bitter— shitter 3 

Hammer— lemon 13 

Thirsty— flrsten 3 

City— 

Square — birds 19 

Butter — shudder 10 

Doctor — shoctor 3 

Loud— souse 10 

Thief— sheaf 10 

Lion— Zion 10 

Joy — bloy 3 

Bed — wading 19 

Heavy — shleavy 3 

Tobacco — confecker 4 

Baby— savey 3 

Moon — shoon 3 

Scissors^ 

Quiet— ahiet 3 

Green — aheel 4 

Salt— shawlt 3 

Street— freet 3 

King— sing 10 

Cheese — seefs 4 

Blossom— pleasant 9 

Afraid — shraid 3 



Case No. 3606. — F. W. Neologisms ; some particles ; many unclassified 
reactions, mostly incoherent. 



Table — pleasure 9 

Dark— air 19 

Music — walking 19 

Sickness — gloves 19 

Man— fields 19 

Deep — courtesy 19 

Soft — spoons 19 

Eating — oranges 

Mountain— ice 17 

House — paintings 2 

Black— blue 

Mutton — hemisphere . . . .19 

Comfort— flowers 19 

Hand — sawdust 19 

Short— peanuts 19 

Fruit— autoharp 19 

Butterfly — disease 19 

Smooth— ice 

Command — botheration . .19 

Chair— tea 19 

Sweet — arrangement ... .19 

Whistle— steadfast 19 

Woman — flowers 15 

Cold— grandeur 19 

Slow — present 19 

Wish— mania 19 

River — courtesy 15 

White— ink 17 

Beautiful — flowers 

Window— air 

Rough — enjoyment 19 

Citizen — queer 19 

Foot— hatred 19 

Spider — carousy 4 



Needle — pleasant 9 

Red— permit 19 

Sleep — indeed 12 

Anger— benevolence 19 

Carpet— disorder 19 

Girl — caterer 19 

High — aside 10 

Working— among 12 

Sour- destroy 19 

Earth — confusion 19 

Trouble — frivolous 19 

Soldier — air 15 

Cabbage — temptation ... 19 

Hard — among 12 

Eagle — quality 19 

Stomach — debasteaur ... 4 

Stem— counteract 19 

Lamp — testament 19 

Dream — connexus 4 

Yellow — division 19 

Bread— atherey 4 

Justice — anger 19 

Boy — quality 15 

Light— among 12 

Health — frivolous 15 

Bible — permit 15 

Memory — usual 19 

Sheep — astray 

Bath— conscientious 19 

Cottage — texaloua 4 

Swift— patience 19 

Blue — community 19 

Hungry— confusion 15 

Priest— second 19 



Ocean — apology 19 

Head— trinity 19 

Stove — compartment 19 

Long — term inal 19 

Religion— abundant 19 

Whiskey — approvement . . 4 

Child— anger 15 

Bitter — courageous 19 

Hammer — correction . . . .19 

Thirsty— afterwards 12 

City— cataract 19 

Square — plenty 19 

Butter— accost 19 

Doctor — southern 19 

Loud— triangular 19 

Thief — cannery 19 

Lion — practice 19 

Joy — summons 19 

Bed — avron 4 

Heavj' — olenthegolis .... 4 

Tobacco — abundant 15 

Baby — parenthus 4 

Moon — otherwise 12 

Scissors — cartridge 19 

Quiet — outside 12 

Green- abounty 4 

Salt — calonry 4 

Street — abyss 19 

King — cavenry 4 

Cheese — perplex 19 

Blossom — cartridge 15 

Afraid— stubborn 19 



348 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



EPILEPSY. 

Most of the cases of epilepsy in our collection show advanced 
dementia and in some the clinical history would indicate also 
original mental inferiority, that is to say, imbecility or feeble- 
mindedness. 

In these cases the dominant characteristic, so far as shown in 
the test records, seems to be a narrowing of the mental horizon 
manifested firstly by a tendency to repeat many times one or 
another word, and secondly by an abnormally pronounced ten- 
dency to make use of non-specific reactions or particles of speech. 
Occasionally other abnormalities are noted, such as perseveration 
or distraction. 

We submit here copies of some test records. 



Case No. 5410, — W. T. K. Repetition of words previously given; non- 
specific reactions. 



Table— article 1 

Dark — light ... 

Music — tone 

Sickness— ill 

Man — person 1 

Deep — distant 2 

Soft — condition 6 

Eating — chew 

Mountain— high 

House — abode 

Black — color 

Mutton — meat 

Comfort — peace 

Hand— limb 

Short — distance 

Fruit— result 

Butterfly — animal 

Smooth — plain 

Command — order 

Chair— seat 

Sweet — pleasant 1 

Whistle — sound 

Woman — female 

Cold— chilly 

Slow— pace 

Wish— desire 

River — body 

White — clear 

Beautiful — grand 

Window— place 13 

Rough— unsm 00 th 4 

Citizen— member 

Foot — member 

Spider— animal 



Needle — article 1 

Red — color 

Sleep— rest 

Anger — condition 6 

Carpet — covering 

Girl — female 

High — distance 

Working— occupation . . . 

Sour — condition 6 

Earth— planet 

Trouble — condition 6 

Soldier — member 6 

Cabbage — vegetable 

Hard — condition 6 

Eagle — animal 

Stomach — member 

Stem — branch 

Lamp — article 1 

Dream — thinking 1 

Yellow — shade 

Bread- article 6 

Justice — position 19 

Boy — male 

Light — clear 

Health — condition 

Bible — book 

Memory — condition 6 

Sheep — animal 

Bath— position 15 

Cottage — house 

Swift— fast 

Blue — color 

Hungry — condition 6 

Priest — office 



Ocean— body 

Head — member 

Stove — article 1 

Long — distance 

Religion — profession .... 

Whiskey— liquid 

Child— person 1 

Bitter — condition 6 

Hammer — article 1 

Thirsty — condition 6 

City— place 

Square — honest 

Butter— article 6 

Doctor — profession 

Loud — sound 

Thief — position 15 

Lion — animal 

Joy — pleasant 1 

Bed— article 6 

Heavy — weight 

Tobacco — plant 

Baby — person 1 

Moon — planet 

Scissors — article 1 

Quiet — peaceful 

Green — shade 

Salt— article 1 

Street— place 

King — ruler 

Cheese — article 6 

Blossom — plant 

Afraid— fear 



igio] 



GR.\CE HELEN 



KENT AND A. J. ROSANOFF 



Case No. 2208.-J. A. 
specific reactions. 



Repetition of words previously given; 



349 



non- 



.13 
.14 
.17 



.19 



Table— wood 

Dark — chairs 

Music— wood 

Sickness— dropsy . 

Man— body 

Deep— well 

Soft- lady 

Eating— man . . . 
Mountain— hilU . 

House— barns ' 

Black— horse 

Mutton— sheep . 

Comfort- poison *» 

Hand— man , 

Short— people 

Fruit— trees 

Butterfly— tree 

Smooth-people " 

Command-general 

Chair— hands 

Sweet— (ruit . 

Whistle— man 

■Woman— people 

Cold— ice g 

Slow— people ,g 

Wish— dead 

River— lakes ._ 

White— foam '' 

Beautiful— man 

Window— glass 

Bough- people ^ 

Citizen— man g 

Foot— people ,, 

Spider— bam 

Case No. 01218.— E. 
specific reactions. 



Needle— clothes 

Bed— blood 

Sleep— bed 

Anger— angry 

Carpet-stores i" 

Girl— ladies ' 

High— mountain 

Working— people ° 

Sour— fruit 

Earth— clay , 

Trouble— bad , 

Soldier— man 

Cabbage— field 

Hard- case 

Eagle— bird , 

Stomach— man 

Stem— pipe 

Lamp— fire ^ 

Dream— bad ., 

Yellow— chair " 

Bread— rye 

Justice— right ^ 

Bov— bad ,g 

Light— ship ,g 

Health— pig g 

Bible— man 

Memory— mind 

Sheep— mutton 

Bath— water 

Cottage— house 

Swift— ship jy 

Blue— lines .• g 

Hungry- people 

Priest— man 



Ocean— deep g 

Head— bad 

Stove— wood „ 

Long— trees 

Beligion— forrn * 

Whiskey— apples •■' 

Child— people ' 

Bitter— apples 

Hammer— aw 

Thirsty— drink 

City— towns ••• 

Square— measurement ..• 

Butter— cows . 

Doctor— person ^ 

Loud— people t: 

Thief— person 

Lion— animal g 

Joy— person g 

Bed— man .■ 

Heavy— mountain 

Tobacco— growing 

Baby— person g 

Moon— people 

Scissors— cutting 

Quiet- mind g 

Green— cloud , 

Salt— planting " 

Street- walk „ 

King— human 

Cheese — milk 

Blossom— flowers 

Afraid— human '" 



M. 



Repitition of words previously given; 



non- 



Table— tablecloth 

Dark— dog jy 

Music— figure ,- 

Sickness— drink '^ 

Man— people ^g 

Deep— pull 

Soft— light J 

Eating— think g 

Mountain— well 

House— plumber 

Black— horse ^g 

Mutton— park . 

Comfort— nice ^ 

Hand— use 

Short— long 

Fruit— figs •■• 19 

Butterfly— cloth ^^ 

Smooth— nice ..••• g 

Command-pleasant ..--^ 

Chair— wash 

Sweet— sour -g 

Whistle— mug jg 

Woman— pear 

Cold— warm 

Slow— quickness ^ 

Wish— nice , 

River— pleasant g 

White— use .■••• .g 

Beautiful-comfort ^| 

Window— looks 

Bough-pleasant 

Citizen— comfort 

Foot— help 'ig 

Spider— wake 



Needle— use ,. 

Bed— look , 

Sleep— good ^ 

Anger— no ^g 

Carpet— make 

Girl— happy - 

High— nice • , 

Working-pleasant ^ 

Sour— bag ..■ 

Earth- ground 

Trouble— good 

Soldier— clothes 

Cabbage— eat , 

Hard- good , 

Eagle— pleasant " 

Stomach— hurt 

Stem— use 

Lamp— lighted .. 
Dream— pleasant . 
Yellow— wake ... 

Bread— making 

Justice— help . 

Bov— pleasant " 

Light— big \ 

Health— nice " 

Bible— use ,, 

Memory— no - 

Sheep— pleasant " 

Bath— good . 

Cottage-useful ° 

Swift— quick 

Blue— good „ 

Hungry— sour 

Priest— good 



. 1 
.15 



Ocean— useful . 

Head— nice „ 

Stove— lighted .g 

Long— lake ...■•• g 

Beligion-pleasant ° 

Whiskey— use . 

Child— help 

Bitter— sour -g 

Hammer— stick 

Thirstv— drink 

City-handy g 

Square— pleasant 

Butter— useful 

Doctor— help „ 

Loud— make „ 

Thief— punish g 

Lion— bad j 

jov— happy J 

Bed— pleasant 

Heavy— light .■•• , 

Tobacco— pleasant 

Bahv— help 

Moon— sun ■ . 

Scissors— pleasant 

Quiet- sleep jg 

Green- beans ^g 

Salt— handy ^j 

Street— make g 

King- nice ^ 

Chces(^-good , 

Blossom— pleasant ^^ 

Afraid— will 



350 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 4989. — C. H. Repetition of words previously given; non- 
specific reactions; particles. 



Table— work 1 

Dark— true 19 

Music — pleasant 1 

Sickness — well 

Man — absent 19 

Deep — together 12 

Soft— plenty 6 

Eating— good 1 

Mountain— together 12 

House — one 12 

Black — America 19 

Mutton— vegetable 2 

Comfort — sleep 

Hand— nothing 19 

Short— never 12 

Fruit— vegetable 

Butterfly- bird 

Smooth— large 9 

Command — willing 

Chair— good 6 

Sweet— always 6 

Whistle — music 

Woman — one 12 

Cold — medium 6 

Slow — quick 

Wish — hope 

River— lake 

WTiite — always 6 

Beautiful — medium 6 

Window — open 

Rough — smooth 

Citizen — American 

Foot— two 

Spider — butterfly 



Needle — steel 

Red — color 

Sleep — plenty 

Anger — never 

Carpet— floor 

Girl- five 12 

High — medium 

Working — always 

Sour — never ... 6 

Earth— cultivate 17 

Trouble — none 

Soldier— willing 15 

Cabbage— vegetable 

Hard — seldom 12 

Eagle — American 

Stomach — no 12 

Stem — one 12 

Lamp — burning 

Dream — always 6 

Yellow — sometimes 12 

Bread — soft 

Justice — always 

Boy— two 12 

Light— plenty 

Health — plentv 

Bible— Catholic 17 

Memory — good 1 

Sheep — wool 

Bath— good 1 

Cottage — plenty 6 

Swift — medium 6 

Blue — never 6 

Hungry — seldom 6 

Priest — good 1 



Case No. 4847. — C. C. Distraction. 



Table — eat 

Dark— lock 10 

Music — fiddle 

Sickness— doctors 2 

Man — woman 1 

Deep — water 

Soft— snow 

Eating — oats 17 

Mountain — spray 19 

House — building 

Black— red 15 

Mutton— meat 9 

Comfort — red 15 

Hand — people 9 

Short— world 19 

Fruit— age 13 

Butterfly— bird 

Smooth — eggs 18 

Command — cake 19 

Chair — world 15 

Sweet— cherries 

Whistle — peaches 18 

Woman — children 

Cold— summer 17 

Slow— brother 19 

Wish- pear 19 

River— orange 18 

White— black 

Beautiful— red 13 

Window — door 

Rough— table 

Citizen — couch 19 

Foot — arm 

Spider— fly 



Needle — scissors 17 

Red— blue 

Sleep— pink 13 

Anger — box 19 

Carpet— TUg 

Girl — boy 

High—piay 

Working — cup 19 

Sour— bread 17 

Earth- picture 19 

Trouble— soap 19 

Soldier— towel 18 

Cabbage — turnip 

Hard — tree 

Eagle — clock 19 

Stomach— eat 

Stem— aoap 15 

Lamp — oil 

Dream — glass 13 

Yellow— bottle 18 

Bread — soap 15 

Justice — pencil 19 

Boy — picture 15 

Light — darkness 

Health— wash stand 19 

Bible — book 

Memory — saucer 19 

Sheep — chair 19 

Bath — bureau 14 

Cottagt — pan 19 

Swift— towel 15 

Blue— wash 2 

Hungry — eat 

Priest — church 



Ocean — three 12 

Head — good 1 

Stove — burning 

Long — medium 

Religion — willing 15 

Whiskey— some 19 

Child— good 1 

Bitter — never 6 

Hammer— tool 

Thirsty— seldom 6 

City— New York 

Square — always 6 

Butter — good 1 

Doctor — good 1 

Loud — medium 6 

Thief — none 

Lion — animal 

Jov — plenty 6 

Bed— good 1 

Heavy — medium 6 

Tobacco — yes 12 

Baby — more 19 

Moon — bright 

Scissors — sharp 

Quiet — plenty 6 

Green— good 6 

Salt— little 19 

Street— lots 18 

King — none 

Cheese — seldom 6 

Blossom — always C 

Afraid — sometimes 15 



Ocean — beans 19 

Head — prunes 18 

Stove — cook 

Long— flg 19 

Religion — church 

Whiskey — tea 17 

Child — people 1 

Bitter — stomach 19 

Hammer— tack 

Th iraty— peach 15 

City — box 15 

Square — soap 15 

Butter— lard 

Doctor — sick 

Loud— head 19 

Thief— cup 15 

Lion— bottle 15 

Joy — pitcher 19 

Bed — sheet 

Heavy— blanket 13 

Tobacco — mustard 19 

Baby— pepper 18 

Moon— heater 19 

Scissors— string 

Quiet— lace 19 

Green— red 

Salt— soda 17 

Street— soldier 19 

King— box 15 

Cheese — cake 

Blossom- shell 19 

Afraid— blotter 19 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



351 



Case No. 3597. — L. T. 

Table — stand 

Dark— lisiht 

Music — instrument 

Sickness — health 

Man — female 

Deep — deptableness 4 

Soft— hard 

Eating— starving 

Mountain— isthmus 17 

House — building 

Black — white 

Mutton— beef 

Comfort — patient 

Hand— leg 

Short — long 

Fruit — vegetable 

Butterfly — spider 

Smooth — coarse 

Command — thought 1 

Chair— utensil 19 

Sweet— sour 

Whistle — trumpet 

Woman — man 1 

Cold — warm 

Slow — quick 

Wish — command 

River- lake 

White— black 

Beautiful— pretty 1 

Window — door 

Rough — straight 

Citizen— tramp 19 

Foot— arm 

Spider— fly 



Some neologisms, all possessing obvious meaning. 



Needle — pin 

Red— blue 

Sleep— awake 

Anger— patient 2 

Carpet— rug 

Girl — servant 

High— low 

Working- laziness 

Sour— sweet 

Earth — hemisphere 

Trouble— goodness 9 

Soldier— merchant 17 

Cabbage — pumpkin 17 

Hard— tight 

Eagle — hawk 

Stomach — abdomen 

Stem— leaf 

Lamp — lantern 

Dream — nightmare 

Yellow— lavender 17 

Bread— pastry 

Justice — badness 2 

Boy— child 

Light — darkness 

Health—sickness 

Bible — testament 

Memory — remember .... 

Sheep — lamb 

Bath — dirtiness 2 

Cottage — building 

Swift — quickly 

Blue — redness 2 

Hungry — starving 

Priest — minister 



Ocean — sea 

Head— topness 4 

Stove — cooking 

Long— shorter 2 

Religion — wickedness . . . 

Whiskey — medicine 

Child— ^daughter 

Bitter— sweetness 2 

Hammer — pickaxe 17 

Thirsty — drinkness i 

City — village 

Square — straightness .... 2 

Butter— ST,Tup 17 

Doctor — queen 19 

Loud — low 

Thief — burglar 

Lion — tiger 

Joy — enjoyable 2 

Bed — bedstead 

Heavy— lightness 

Tobacco — sweetness 2 

Baby— infant 

Moon — sun 

Scissors — shears 

Quiet — noiseness 4 

Green—greenbill 3 

Salt — sugar 

Street— island 19 

King — nephew 19 

Cheese — curdness 4 

Blossom — bud 

Afraid — knowledgeable . . 4 



GENERAL PARESIS. 

Cases presenting no considerable dementia or confusion and 
cases in a state of remission are apt to give normal test records. 
As we proceed from the records of such cases to those of cases 
showing mental deterioration we observe a gradual reduction in 
the values of reactions, contraction of the mental horizon,' and 
the appearance of the phenomenon of perseveration. We submit 
the following test records for illustration: 



* What we mean by contraction of the mental horizon has already been 
described in connection with epilepsy, page 182. 



352 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 4047. — C. A. F. Almost complete remission of all mental symp- 
toms. Normal record. 



Table — dish 

Dark— light 

Music — sound 

Sickness — disease 

Man — woman 1 

Deep — fathomless 

Soft— sweet 

Eating— food 

Mountain — high 

House— barn 

Black — color 

Mutton — meat 

Comfort— ease 

Hand — foot 

Short— long 

Fruit — sweet 

Butterfly — moth 

Smooth — rough 

Command — order 

Chair— leg 

Sweet— pleasant 1 

Whistle — sound 

Woman— female 

Cold — ice 

Slow — languid 17 

Wish — desire 

River — long 

White — color 

Beautiful— fair 

Window — glass 

Rough — smooth 

Citizen — voter 

Foot — toe 

Spider — fly 



Needle — sharp 

Red — color 

Sleep — slumber 

Anger — rage 

Carpet — sweep 

Girl— maiden 

High— lofty 

Working — toiling 

Sour — distasteful 

Earth — ground 

Trouble — sorrow 

Soldier— fighter 

Cabbage— leaf 

Hard — easy 

Eagle— fly 

Stomach — food 

Stem — petal 

Lamp — light 

Dream — slumber 

Yellow — color 

Bread — eat 

Justice — judgment 

Boy — youth 

Light — lamp 

Health — nature 17 

Bible— holy 

Memorj'— remember 

Sheep — lamb 

Bath — water 

Cottage — house 

Swift — fast 

Blue — color 

Hungry — famished 

Priest— holy 



Ocean— sea 

Head— top 

Stove — fire 

Long — short 

Religion — holy 

Whiskev^drink 

Child— infant 

Bitter — sour 

Hammer— knock 

Thirsty— drink 

City — town 

Square — round 

Butter— eat 

Doctor— phj'sician 

Loud — knock 

Thief— steal 

Lion — tiger 

Joy— happiness 1 

Bed — sleep 

Heavy — weigh 

Tobacco — smoke 

Baby— child 

Moon — stars 

Scissors — cut 

Quiet — soft 

Green— color 

Salt— food 

Street— lane 

King — queen 

Cheese — eat 

Blossom — flower 

Afraid — fear 



Case No. 6660. — F. F. Repetition of words previously given ; non- 
specific reactions ; unclassified reactions some of which are " circum- 
stantial " (see page 16). 



Table— bureau 19 

Dark— boats 2 

Music — piano 

Sickness — doctor 

Man— sober 19 

Deep — cellar 

Soft— easy 

Eating — chewing 

Mountain — climb 

House — tenants 2 

Black — color 

Mutton— meat 

Comfort— easy 

Hand — use 1 

Short— stump 2 

Fruit— nice 1 

Butterfly— like 6 

Smooth — clean 

Command— faithful 17 

Chair — easy 

Sweet— like 6 

Whistle — good 6 

Woman — like 6 

Cold— medicine 

Slow— I 12 

Wish— like 

River- boats 

White— sheet 

Beautiful — flowers 

Window — red 14 

Rough— streets 2 

Citizen — honest 

Foot— walking 

Spider— kiU 19 



Needle — sew 

Red— nice 6 

Sleep— rest 

Anger — cross 

Carpet— good 6 

Girl— nice 1 

High— good 1 

Working — well 19 

Sour — bitter 

Earth — property 19 

Trouble— flghting 

Soldier — good 1 

Cabbage — eat 

Hard— sorry 19 

Eagle— good 6 

Stomach—good 1 

Stem— fair 19 

Lamp — use 1 

Dream — now 12 

Yellow — color 

Bread — good 1 

Justice — fine 1 

Boy — good 1 

Light— good 1 

Health— right 19 

Bible — home 

Memory — good 1 

Sheep— like 6 

Bath — good 1 

Cottage — fine 1 

Swift— go 

Blue — nice 6 

Hungry — bad 1 

Priest— Father 



Ocean— boats 

Head — brains 

Stove — heat 

Long — streets 

Religion— Catholic 

Whiskey — bad 1 

Child— good 1 

Bitter — sorrow 

Hammer — use 1 

Thirsty — drink 

City — Brooklyn 

Square — parka 2 

Butter— ice 19 

Doctor — cure 

Loud — holler 

Thief— no 2 

Lion— no ; 6 

Joy — hope 

Bed — rest 

Heavy— load 

Tobacco — good 

Baby — good 

Moon— light 

Scissors— UBe 

Quiet — good 

Green — nice 

Salt — use 

Street— nice 

King— right 19 

Cheese — nice X 

Blossom — grow 

Afraid — no 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



353 



Case No. 6185. — R. N. Numerous particles of speech; some unclassified 
reactions, chiefly "circumstantial" (see page 16). 



Table — eat 

Dark — cloudy 

Music — fond 19 

Sickness— well 

Man — human 

Deep — ocean 

Soft— fine 1 

Eating — yes 6 

Mountain — yes 5 

House — yes o 

Black — yes 8 

Mutton— yes 5 

Comfort — yes 5 

Hand — finger 

Short— yes 6 

Fruit— yes 5 

Butterfly— yea 5 

Smooth — even 

Command — obey 

Chair— settle 17 

Sweet— bitter 

Whistle— can't 19 

Woman — lady 

Cold— ice 

Slow — fast 

Wish — give 

River — enjovment 19 

White— black 

Beautiful — yea 6 

Window — pane 

Rough — smooth 

Citizen— yes 6 

Foot — one 12 

Spider — yes 6 



Needle — sewing 

Red— blue 

Sleep— nap 17 

Anger — willing 19 

Carpet^j'es 6 

Girl— nature 19 

High — low 

Working— artist 17 

Sour — sweet 

Earth— world 

Trouble — peaceful 

Soldier— no 12 

Cabbage— vegetable 

Hard—soft 

Eagle — American 

Stomach — condition .... 

Stem— post 17 

Lamp — light 

Dream—thinking 1 

Yellow — green 

Bread — loaf 

Justice— yes 

Boy — human 

Light— heaven 

Health — wealth 

Bible — yes 6 

Memory— yes 5 

Sheep — animal 

Bath— yes 6 

Cottage— yes 5 

Swift— fast 

Blue — gray 

Hungry — no 

Priest— yes 6 



Ocean — water 

Head— human 

Stove — coal 

Long — short 

Religion— yes 6 

Whiskev — no 12 

Child— baby 

Bitter — sweet 

Hammer— pincher 17 

Thirsty — drinking 

City— population 

Square — circle 

Butter— lard 

Doctor- physician 

Loud — low 

Thief— penalty 17 

Lion — liar 10 

Joy— welcome 17 

Bed — sleep 

Heavy— light 

Tobacco — yes 6 

Baby— human 

Moon — natural 15 

Scissors — no 12 

Quiet — yea 6 

Green — shade 

Salt— eat 

Street — town 

King— ruler 

Cheese — eat 

Blossom— blooming 

Afraid — scared 



Case No. 6518. — C. Z. Perseveration shown by numerous instances of 
association to preceding reaction. 



Table— horse 19 

Dark — wren 19 

Mdsic— lark 18 

Sickness — cold 

Man — woman 1 

Deep — sea 

Soft— hard 

Eating — drinking 

Mountain — fountain 

House — bam 

Black— stable 13 

Mutton — cow 

Comfort — horse 18 

Hand— lamb 18 

Short— calf 18 

Fruit — apples 

Butterfly— oranges 2 

Smooth — peaches 18 

Command — plums 18 

Chair— bench 

Sweet — sugar 

AVhistle — drum 17 

Woman— man 1 

Cold— hot 

Slow — fast 

Wish— who 12 

River — water 

White— blue 

Beautiful — splendid 

Window — sashes 2 

Rough — ready 

Citizen— Brooklyn 

Foot— shoe 

Spider — web 



Needle — pin 

Red— blue 

Sleep — awake 

Anger— bad 1 

Carpet — sweeper 

Girl— boy 

High — low 

Working— playing 

Sour — sweet 

Earth — ground 

Trouble — wheelbarrow . .19 

Soldier— Mexican 17 

Cabbage — potatoes 

Hard— beets 18 

Eagle— carrots 18 

Stomach— peas 18 

Stem — peas 5 

Lamp — burning 

Dream — happy 1 

Yellow — blue 

Bread — green 13 

Justice — freedom 

Boy — girl 

Light— burning 

Health — strength 

Bible — prayerbook 

Memory — thoughts 1 

Sheep— lamb 

Bath — water 

Cottage — house 

Swift— whist 10 

Blue — red 

Hungry — eating 

Priest— Father 



Ocean — mother 18 

Head— brother 18 

Stove — sister 18 

Long— freedom 15 

Religion — smart 19 

Whiskev — wine 

Child— lamb 19 

Bitter— goat 18 

Hammer — nails 

Thirstv — dry 

City— talking 19 

Square — inches 

Butter — cheese 

Doctor — bread 13 

Loud— oranges 15 

Thief —almonds IS 

Lion— apples 18 

Joy— grapes 18 

Bed— peaches 18 

Heavy — cranberries 18 

Tobacco — grapes 18 

Baby — watermelons 18 

Moon— muskmelons 18 

Scissors — citrons 10 

Q\iiet—flqu ashes 18 

Green — pumpkins 18 

Salt — cucumbers 18 

Street— tomatoes 18 

King — pears 18 

Cheese — apples 18 

Blossom — clierries 

Afraid — gooseberries 18 



354 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 5329. — B. W. Perseveration ; record almost entirely made up 
of instances of association to preceding reaction. 



Table — San Francisco ...19 
Dark — comprehensible . .10 

Music — sinking 

Sickness — Brooklyn 19 

Man — woman 1 

Deep — amazing 19 

Soft—pleasant 9 

Eatinp — digesting 

Mountain — gulf 17 

House — peninsula 18 

Black— Constantinople . .18 

Mutton— Bermuda 18 

Comfort- Los Angeles ..18 

Hand— Cuba 18 

Short— cities 18 

Fruit— Iowa 18 

Butterfly— England 18 

Smooth— Russia IS 

Command— TJurkey 18 

Chair— Manila 18 

Sweet— Porto Rico 18 

Whistl^Washington ...18 
Woman — Cincinnati . . . .18 

Cold— Pittsburg IS 

Slow— Philadelphia 

Wish— Mil waukee IS 

River— St. Louis 18 

White— Japan 18 

Beautiful— China 18 

Window— Berlin IS 

Rough — Glasgow 18 

Citizen— London 18 

Foot— Dublin 18 

Spider— Sacramento 18 



Needle— Texas 18 

Red— North Carolina ...18 

Sleep— Florida 18 

Anger— Seattle 18 

Carpet— Nevada 18 

Girl — Iowa 15 

High— Virginia IS 

Working — Louisiana . . . .18 

Sour — Hawaii 18 

Earth— Connecticut 18 

Trouble— Rhode Island ..18 

Soldier — Vermont IS 

Cabbage — Massachusetts. .18 

Hard— Hudson 18 

Eagle— East River 18 

Stomach — Staten Island.. 18 

Stem— Kings Park 18 

Lamp — Fort Lee 18 

Dream — Long Island 18 

Yellow — Greenport 18 

Bread- Southold 18 

Justice — Northport 18 

Boy — New Jersey 18 

Light— Rome IS 

Health— Italy IS 

Bible — Episcopal 17 

Memory — Methodist 18 

Sheep— Congregational. . .18 

Bath— Baptist 18 

Cottage — minister 18 

Swift — physician 18 

Blue — horse 13 

Hungry — cow 18 

Priest— Catholics 



Ocean — lake 

Head— bay 

Stove — sound 

Long — Island 

Religion — Boston 

Whiskev — Harvard 

Child— Yale 

Bitter — Columbia 

Hammer— library 

Thirstv — Carnegie 

City— Rockefeller 

Square — Harriman 

Butter — Leggitt 

Doctor — Lincoln 

Loud — Roosevelt 

Thief— Taft 

Lion — Gaynor 

Jov — Slocum 

Bed— Grant 

Heavy — McClellan 

Tobacco — Spain 

Baby — New London 

Moon — Newburgh 

Scissors — Troy 

Quiet — Schenectady 

Green— Lake George . . . 

Salt — Vienna 

Street — .\lsace Lorraine- 

King— Garfield 

Cheese — McKinley 

Blossom— Bryan 

Afraid — Blaine 



MANIC-DEPRESSIVE INSANITY. 

In this disorder the departures from the normal seem to be less 
pronounced than in the psychoses considered above. The number 
of individual reactions is in most cases not greatly above the 
nomial average ; and, so far as their character is concerned, we 
find that many of them are classed as normal, in accordance with 
the appendix to the frequency tables ; among the unclassified re- 
actions, which are quite frequent here, we find mostly either 
obviously normal ones, or some of the type to which we have 
already referred as " far-fetched," while others among them are 
"circumstantial" (see p. i6) ; further we find that most of the 
remaining individual reactions fall into the general group of 
partial dissociation : non-specific reactions, sound reactions, word 
complements, and particles. 

In some cases the only abnormality that is found is that of an 
undue tendency to respond by non-specific reactions, most of them 
being common and there being no excessive number of individual 
reactions. It would seem legitimate to assume that this tendency 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



355 



is here to be regarded as a manifestation of the phenomenon which 
is clinically described as dearth of ideas. It is significant that 
this tendency is observed not only in depressive phases of the 
psychosis, but also in manic phases and even in the normal inter- 
vals of recurrent cases or after apparent recovery in acute cases ; 
this will be seen from some of the test records which are here 
reproduced. 

Occasionally cases are met with which give a large number of 
unclassified reactions, seemingly incoherent. There can be no 
doubt that at least some of these cases are clinically perfectly 
typical ones of manic-depressive insanity, yet the test records 
strongly resemble, in some respects, those of dementia prsecox. 
Since clinically the distinction between typical cases of these psy- 
choses can be so clearly made on the basis of the disorders of the 
flow of thought respectively characterizing them, it could hardly 
be assumed that the associational disturbances in these two groups 
of cases are truly related, although there may be an apparent 
resemblance ; it must be acknowledged that we are here con- 
fronted with one of the most serious shortcomings of the asso- 
ciation test, or at least of the present method of applying it. 



Case No. 5236. — M. B. 

Table — eat 

Dark — night 

Music — play 

Sickness — death 

Man— health 13 

Deep — depth 

Soft— hard 

Eating — chewing 

Mountain — high 

House — living 

Black — color 

Mutton — sheep 

Comfort— kind 2 

Hand — body 

Short — small 1 

Fruit— garden 

Butterfly— spring 

Smooth — rough 

Command — obey 

Chair — sit 

Sweet— apple 

Whistle — music 

Woman — kind 

Cold— chilly 

Slow — easy 

Wish — want 

River — water 

White — color 

Beautiful—grand 

Window — light 

Rough — smooth 

Citizen — man 1 

Foot— body 

Spider — animal 



Depressive attack. Normal record. 



Needle — sew 

Red — color 

Sleep — rest 

Anger — badness 2 

Carpet— floor 

Girl — young 

High — low 

Working — busy 

Sour— sweet 

Earth — live 

Trouble — grief 

Soldier — army 

Cabbage — garden 

Hard — stone 

Eagle — bird 

Stomach — body 

Stem — plant 

Lamp — light 

Dream — sleep 

Yellow — color 

Bread — eat 

Justice — kind 2 

Boy — young 

Light— day 

Health — strength 

Bible— Christ 

Memory — think 1 

Sheep — mutton 

Bath — clean 

Cottage — live 

Swift— run 

Blue — color 

Hungry — food 

Priest — clergy 



Ocean — water 

Head — body 

Stove — fire 

Long- tall 

Religion — teaching 

WTiiskey — drink 

Child — young 

Bitter — sweet 

Hammer — nail 

Thirsty— drink 

City — town 

Square — four 

Butter— eat _ ... 

Doctor — medicine 

Loud — noise 

Thief— steal 

Lion — beast 

Joy — kind 6 

Bed — sleep 

Heavy — weight 

Tobacco — smoke 

Baby— mother 

Moon — light 

Scissors — cut 

Quiet— kind 6 

Green — grass 

Salt— table 

Street — walk 

King— government 

Cheese — eat 

Blossom— tree 

Afraid — coward 



35^ 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 6120. — M. L. Maniacal attack. Fifteen individual reactions, 
of which II are classed as normal in accordance with the appendix to the 
frequency tables. 



Table — chair 

Dark— light 

Music — chorus 17 

Sickness— health 

Man — woman 1 

Deep — around 

Soft— light 

Eating — food 

Mountain— valley 

House— flat 17 

Black — white 

Mutton — beef 

Comfort — disease 

Hand— legs 

Short— tall 

Fruit — grapes 

Butterfly — birds 

Smooth— rough 

Command — president . . .17 

Chair- assemblyman 18 

Sweet— bitter 

^VhistIe — birds 

Woman— man 1 

Cold— warm 

Slow— fast 

Wish — well 

River — mountain 

WTiite — red 

Beautiful— heaven 

Window — door 

Rough— smooth 

Citizen— naturalization. . 

Foot — hand 

Spider— bug 

Case No. 6367.— J. N. 

both classed as normal 

Table— cup 17 

Dark— light 

Music— song 

Sickness — pain 

JJan — child 

Deep — high 

Soft— hard 

Eating— tasting 

Mountain— valley 

House — room 

Black— white 

Mutton— lamb 

Comfort — peace 

Hand — foot 

Short— long 

Fruit — apple 

Butterfly — moth 

Smooth— rough 

Command — obey 

Chair— table 

Sweet — sour 

Whistle — song 

Woman— love 

Cold — warm 

Slow— fast 

Wish- well 

River — water 

White— black 

Beautiful — grand 

Window — glass 

Rough — smooth 

Citizen— man 1 

Foot— hand 

Spider— fly 



Needle — doctor 19 

Red — white 

Sleep — well 

Anger — passion 

Carpet — cloth 

Girl — boy 

High— low 

Working— pleasure 1 

Sour — sweet 

Earth — heaven 

Trouble — anger 

Soldier- mine 12 

Cabbage — steak 17 

Hard- soft 

Eagle — parrot 

Stomach— pelvis 17 

Stem — flowers 

Lamp — light 

Dream — empty 17 

Yellow — black 

Bread — brown 

Justice — done 

Boy— baby 

Light— heaven 

Health — wealth 

Bible — love 

Memory — remembrance. . . 

Sheep — goat 

Bath— water 

Cottage — house 

Swift — slow 

Blue — green 

Hungry— I 

Priest — minister 



Ocean — sea 

Head — neck 

Stove — electricity 17 

Long— broad 

Religion — Presbyterian .. 
Whiskey — medicinal .... 2 

Child— boy 

'Bitter — sweet 

Hammer — saw 

Tbirstv — water 

City— Middletown 17 

Square — Madison 

Butter — bread 

Doctor — love 15 

Lioud — soft 

Thief— burglar 

Lion — animal 

Joy — ecstasy 

Bed — couch 

Heavy— lead 

Tobacco — smoke 

Baby — boy 

Moon — stars 

Scissors — cotton 17 

Quiet — noisy 

Green — yellow 

Salt— pepper 

Street— Dean 17 

King— God 17 

Cheese— Roquefort 

Blossom — apple 

Afraid — never 



Depressive attack. Only two individual reactions, 
undue tendency to give non-specific reactions. 



Needle — thread 

Red— blue 

Sleei>— rest 

Anger — passion 

Carpet— rug 

Girl-child 

High — low 

Working— labor 

Sour — sweet 

Earth— ground 

Trouble — overcome 17 

Soldier— brave 

Cabbage — lettuce 

Hard — soft 

Eagle — bird 

Stomach — heart 

Stem — tree 

Lamp — light 

Dream — sleep 

Yellow—red 

Bread — roll 

Justice — peace 

Boy — child 

Light — sun 

Health — wealth 

Bible — good 1 

Memory— good 1 

Sheep — lamb 

Bath — water 

Cottage — house 

Swift— fast 

Blue — white 

Hungry — eat 

Priest— man 1 



Ocean— water 

Head — arm 

Stove — warm 

Long — short 

Religion — good 1 

Whiskey — none 

Child— good 1 

Bitter— sour 

Hammer — noise 

Thirsty— water 

City— country 

Square — round 

Butter — salt 

Doctor— good 1 

Loud— noise 

Thief — man 1 

Lion — beast 

Joy— good 1 

Bed — good 1 

Heavy — weight 

Tobacco — smoke 

Baby— child 

Moon — sun 

Scissors — knife 

Quiet— rest 

Green — red 

Salt — water 

Street — city 

King — man 1 

Cheese — butter 

Blossom— flower 

Afraid— fear 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



357 



Case No. 5162.— W, H. Recurrent attacks, mixed in character; at time of 
test patient was in a normal interval. 5 individual reactions, of which i is 
classed as normal, i as a derivative, 2 as non-specific, and i as a sound 
reaction; undue tendency to give non-specific (common) reactions. 



Table — comfort 

Dark — darkne38 8 

Music— pleasure 

Sickness— sorrow 

Man — manners 10 

Deep — thought 

Soft — comfort 

Eating—pleasure 

Mountain— height 

House — comfort 

Black — darkness 

Mutton — eating 

Comfort — pleasure 

Hand— useful 

Short— stumpy 

Fruit — eating 

Butterfly — handsome .... 

Smooth — plane 

Command — ordering .... 

Chair— easy 

Sweet — candy 

Whistle — noise 

Woman — love 

Cold — freezing 

Slow— laziness 

Wish — good 1 

River— water 

White — clearness 2 

Beautiful— handsome . . . 

Window — scene 

Rough — harshness 

Citizen — voting 

Foot— stepping 

Spider — poison 



Needle — sharpness 

Red— blood 

Sleep — comfort 

.\nger— passion 

Carpet — walking 

Girl— lovely 

High — height 

Working— business 

Sour — tart 

Earth — planting 

Trouble — sorrow 

Soldier— fighting 

Cabbage — eating 

Hard— harshness 2 

Eagle — flying 

Stomach—eating 

Stem — vine 

Lamp^lighting 2 

Dream — pleasure 1 

Yellow— color 

Bread— eating 

Justice — suing 17 

Boy — children 

Light — seeing 

Health— pleasiu-e 1 

Bible— thinking 9 

Memory — recollections . . 

Sheep — wool 

Bath — pleasure 1 

Cottage — living 

Swift — quickness 

Blue — sky 

Hungry— pleasure 9 

Priest — holiness 



Ocean — sailing 

Head — thinking 1 

Stove — warmth 

Long— length 

Religion— holiness 

Whiskey — badness 2 

Child— pleasure 1 

Bitter — sourness 

Hammer — pounding .... 

Thirsty — drinking 

City — town 

Square — measure 

Butter — greasy 

Doctor — medicine 

Loud — hearing 2 

Thief — stealing .... ... 

Lion — fierceness 

Joy — pleasure X 

Bed — sleeping 

Heavy — solid 

Tobacco— pleasure 1 

Baby — loveliness 

Moon — bright 

Scissors — sharpness 

Quiet — pleasure 1 

Green — color 

Salt— taste 

Street^walking 

King — majestic 

Cheese — eating 

Blossom — handsome 

Afraid — fear 



Case No. 6279. — A. F. Maniacal attack; at time of test patient had im- 
proved, though not recovered. Non-specific reactions; particles. (Patient 
does not speak English with perfect fluency.) 



Table— board 

Dark — night 

Music — piano 

Sickness — appendicitis . . 

Man— husband 

Deep — hole 

Soft— hard 

Eating— vegetable 

Mountain — country 

House — comfort 

Black — cotton 17 

Mutton— lamb 

Comfort — rest 

Hand — arm 

Short— journey 

Fruit— apples 

Butterfly— love 13 

Smooth — nice 1 

Command — order 

Chair — down 12 

Sweet — sugar 

Whistle— blow 

Woman — good 1 

Cold— ice 

Slow — lazy 

Wish — home 

River— boat 

White— milk 

Beautiful — flowers 

Window — corner 

Rough — man 1 

Citizen — not 12 

Foot— short 

Spider^don't 12 

24 



Needle — steel 

Red— rose 

Sleep — well 

Anger — not 

Carpet— beauty 1 

Girl — love 

High— reason 19 

Working — dress 19 

Sour— vinegar 

Earth— ground 

Trouble — much 

Soldier— blue 

Cabbage — sour 

Hard — no 12 

Eagle — paper 

Stomacb^ — well 17 

Stem— flower 

Lamp — light 

Dream- a wful 19 

Yellow — flower 

Bread — rye 

Justice — court 

Boy— little 

Light — room 

Health— love 15 

Bible — no 12 

Memory— good 1 

Sheep— lot ly 

Bath— cold 

Cottage— little 

Swift— kick 17 

Blue — no 12 

Hungry— no 

Priest— love 15 



Ocean— Grove 

Head— black 

Stove — shine 19 

Long — square 

Religion — no 

Whiskey — champagne . . .17 

Child— my 2 

Bitter — pepper 

Hammer — Imock 

Thirsty— no 12 

City— New York 

Square — table 

Butter— good 1 

Doctor— S 17 

Loud— talk 

Thief— night 

Lion — yes 12 

Joy— good 1 

Bed — comfort 

Heavy — iron 

Tobacco — strong 

Baby — love 

Moon — shine 

Scissors — cut 

Quiet — well 

Green— bow 17 

Salt— bitter 

Street— Hinsdale 17 

King— Franz Joseph 17 

Cheese — Swiss 

Blossom — nice 1 

Afraid— no 



358 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 4578. — E. M. Circular insanity of over twenty years' stand- 
ing; at time of test patient was in a manic phase. Non-specific reactions; 

doubtful reactions; neologisms, all possessing obvious meaning. 



Table — using 1 

Dark— unbright 4 

Music — songs 

Sickness — catching 17 

Man— maflculine 

Deep — high 

Soft— chew 19 

Eating— sometimeB 12 

Mountain — highlands . . . 

House — live ... 

Black — color 

Mutton — meat 

Comfort — easy 

Hand — body 

Short — unlongly 4 

Fruit — plants 

Butterfly — insects 

Smooth — feeling 

Command— do 

Chair — use 1 

Sweet— taste 

Whistlc^act 

Woman — female 

Cold—acting 2 

Slow— gradually 17 

Wish — desire 

River— water 

White — color 

Beautiful— niceness 2 

Window— built 19 

Rough — treatment 17 

Citizen — country 

Foot— body 

Spider^insect 



Needle — article J 

Red — color 

Sleep — tiredness 4 

Anger — scolding 

Carpet — article 1 

Girl— female 

High — low 

Working— do 

Sour — tasting 

Earth — surface 

Trouble — worriment .... 

Soldier — man 1 

Cabbage — vegetable 

Hard— difficult 

Eagle — bird 

Stomach— body 

Stem— article 6 

Lamp — article 1 

Dream — untruly 4 

Yellow — color 

Bread — food 

Justice — unfairly 2 

Boy — masculine 

Light — easy 

Health—sickness 

Bible — commandments . . 

Memory — rememt)er 

Sheep — animal 

Bath — cleanness 

Cottage — country 

Swift — quickly 

Blue — color 

Hungry— food 

Priest — masculine 15 



Ocean — water 

Head — body 

Stove— article 1 

Long — shortly 2 

Religion — Bible 

Whiskey — drinking 

Child— disremembering. . 4 

Bitter — taste 

Hammer— using 1 

Thirsty — drinking 

City— acting 15 

Square — measuring 2 

Butter — food 

Doctor— helping 2 

Loud — hearing 2 

Thief—untrue 15 

Lion— animal 

Joy — gladness 

Bed— l>ing 

Heavy— unlightly 4 

Tobacco — using 1 

Baby — borning 4 

Moon— sending 19 

Scissors — using 1 

Quiet— acting 2 

Green — color 

Salt— food 

Street— walking 

King — person 1 

Cheese — food 

Blossom— plant 

Afraid — frightened 



Case No. 5878. — A. B. Maniacal attack. 48 individual reactions, of 
which 18 are classed as normal, 10 are sound reactions (2 sound neo- 
logisms), I word complement, 8 particles, and 11 unclassified reactions 
most of which are either obviously normal or "far fetched" but not 
strictly incoherent. 



Table — mahogany 

Dark—green 

Music — masonic 10 

Sickness — seasickness . . .10 

Man— maternity 10 

Deep — well 

Soft— silk 

Eating — cleanliness 19 

Mountain— Gibraltar 17 

House — bungalow 

Black— light 

Mutton — lamb 

Comfort — linen 17 

Hand— left 17 

Short— shorthand 10 

Fruit— pears 

Butterfly — canary 17 

Smooth— linen 17 

Command— pilot 17 

Chair — round 

Sweet — sugar 

Whistle— mother 19 

Woman— twenty-one ... 12 

Cold — ice 

Slow— music 

Wish— girl 

River— Hudson 

White— plaster 17 

Beautiful— nature 

Window— St. Patrick's. .17 

Rough— blankets 19 

Citizen — twenty-one . . . .12 

Foot— flix 12 

Spider— fly 



Needle — tailor 

Red— Herald 19 

Sleep — seven 12 

Anger — Angoria 3 

Carpet— green 

Girl— eighteen 12 

High— school 11 

Working— ten 12 

Sour — kraut 

Earth — round 

Trouble— son 19 

Soldier — navy 

Cabbage — curly 19 

Hard — stone - . 

Eagle — almanac 17 

Stomach — stomjack 3 

Stem — maple 17 

Lamp — New York 19 

Dream — husband 19 

Yellow — cards 17 

Bread — rye 

Justice — liberty 

Boy— Joe 

Light — white 

Health— death 10 

Bible— holy 

Memory — seven 12 

Sheep — lamb 

Bath — cleanliness 

Cottage — gray 17 

Swift- ball .,., ... 

Blue— balloon 10 

Hungry — yes 12 

Priest — doctor 



t)cean— Niagara 17 

Head— rest 

Stove — stationary 10 

Long — poems 19 

Religion — Catholic 

Whiskey — Hunter 

Child— Jesus 17 

Bitter— gall 

Hammer— steel 

Thirsty— water 

City— New York 

Square — Union 

Butter— sweet 

Doctor— S 17 

Loud — discreet 19 

Thief— night 

Lion — Bostock 2 

Joy — Joy Line 10 

Bed— Ostermoor 17 

Heavy— iron 

Tobacco — Durham 

Baby— Rose 17 

Moon — half 

Scissors — steel 

Quiet— nursing 19 

Green— grass 

Salt— rock 

Street— Liberty 17 

King— Alphonso 

Cheese — Swiss 

Blossom — apple 

Afraid— dark 



IQIO] 



GR.\CE HELEN KENT AND A. J. ROSANOFF 



359 



Case No. 651 i. — U. B. 

me, I, none, etc. 

Table — none 6 

Dark— red 

Music — stock 19 

Sickness— rose 19 

Man— Frank 17 

Deep — blue 

Soft — pillow 

Eating— no 12 

Mountain — o>'ster 11 

House — mercy 19 

Black— mother 19 

Mutton — me 6 

Comfort— home 

Hand— mother 15 

Short— me 6 

Fruit — me 5 

Butterfly— it 12 

Smooth— oh 12 

Command— none 6 

Chair— none 5 

Sweet— for 12 

Whistle— bird 

Woman — I 6 

Cold— I 5 

Slow— me 

Wish— none 2 

River — are 12 

White— wife 10 

Beautiful — Alma 17 

Window— Stephen 19 

Rough— Rudolphia 10 

Citizen— father 17 

Foot— Anthon 19 

Spider— reverend 19 



Maniacal attack. Persistent use of particles oh, 



Needle — pine 17 

Red— brother 19 

Sleep — Adam 19 

Anger — I 6 

Carpet— home 

Girl— Agatha 17 

High— niece 13 

Working— I 6 

Sour— I 5 

Earth— I 5 

Trouble— I 5 

Soldier— father 15 

Cabbage— hail 19 

Hard— me 12 

Eagle— I 6 

Stomach— I 5 

Stem— life 

Lamp — Lambert 10 

Dream — I 6 

Yellow— I 5 

Bread— I 5 

Justice — I 5 

Boy— just 13 

Light — picture 19 

Health— cook 19 

Bible— beads 17 

Memory— Dick 19 

Sheep— to 12 

Bath — none 

Cottage — home 

Swift— lazv 

Blue— Nell 19 

Hungry — I 

Priest— I 5 



Ocean — I 5 

Head— home 6 

Stove — home 

Long — short 

Religion— none 

Whiskev— none 

Child— Sylvester 17 

Bitter— I 6 

Hammer — my 12 

Thirsty— no 6 

City— no 5 

Square — Ben 19 

Butter— I 6 

Doctor — I 5 

Loud — bell 

Thief— iron 19 

Lion— I 6 

Jov— I 6 

Bed— I 6 

Heavy — I 5 

Tobacco — I 6 

Baby— I 5 

Moon— will 12 

Scissors — beads 15 

Quiet — nerves 19 

Green— I 6 

Salt— I 5 

Street— Peter 17 

King— I 6 

Cheese — I 5 

Blossom — I 5 

Afraid — no 



Case No. 4427. — A. R. Maniacal attack. Unusual number of doubtful 
reactions; 46 individual reactions of which 9 are classed as normal; 29 
are unclassified, some seemingly incoherent. 



Table— Chicago 19 

Dark— Montreal 18 

Muaic — Mississippi 18 

Sickness — flowers 19 

Man — ocean 19 

Deep — medicines 19 

Soft— accidental 19 

Eating— vaccination 19 

Mountain — evergreens . . 17 

House — caves 19 

Black— station 19 

Mutton — operations 19 

Comfort— money 

Hand — bandages 10 

Short — soldiers 19 

Fruit— dictionary 19 

Butterfly—storehouse . . .19 

Smooth— vegetables 18 

Command— Bible 

Chair— histories 14 

Sweet — farewells 19 

Whistle— ammunition ... 19 

Woman — foreign 19 

Cold — armory 19 

Slow— St. Petersburg ...19 

Wish — wealth 

River— revenue 10 

White — purity 

Beautiful— colonial 19 

Window — shutters 

Rough — planes 2 

Citizen — naturalization. . . 

Foot — carriage 19 

Spider— remedies 19 



Needle — canoe 19 

Red— refreshments 10 

Sleep — restfulness 2 

Anger— usefulness 9 

Carpet — coach 19 

Girl— finery 19 

High— fortifications 19 

Working— materials 19 

Sour — picklea 

Earth — gravitation 2 

Trouble — graphophone . . 19 

Soldier— guns 

Cabbage — children 19 

Hard— inheritance 19 

Eagle — feathers 

Stomach— envelope 19 

Stem — roots 

Lamp — oil 

Dream — fairies 17 

Yellow— lemons 2 

Bread— jams 17 

Justice — repentance ... .17 

Boy — clothes 

Light— lanterns 17 

Health— joys 2 

Bible — heaven 

Memory— head 

Sheep— pastures 

Bath — cleanliness 

Cottage — home 

Swift — rapids 2 

Blue— truth 

HungTj'— appetite 

Priest— saint linesa 17 



Ocean — ships 

Head— intelligence 

Stove — woods 2 

Long— trains 2 

Religion — godliness 2 

Whiskey — drunkenness . . 

Child- joyfulness 2 

Bitter — olives 

Hammer — nuts 

Thirsty — water 

City— shopping 

Square — monuments .... 2 

Butter — crackers 17 

Doctor — medicines 

Loud — music 

Thief— detectives 2 

Lion — cages 2 

Joy — home 

Bed — restfulness 2 

Heavy — expressage 17 

Tobacco — cigars 

Baby — carriage 

Moon— light 

Scissors— goods 

Quiet — peacefulneas 

Green — vegetables 

Salt — water 

Street — stones 

King — crown 

Cheese — knife 

Bloaaom- plants 2 

Afraid — enemies 17 



36o 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 6457. — C. G. Depressive attack, s^ individual reactions of 
which are classed as normal and 20 as unclassified; among the latter 
several seem to be incoherent. 



Table— fish 17 

Dark— boat 

Music — water 18 

Sicknesa— tajok 18 

Man — horse 

Deep — ocean 

Soft— egg 

Eating-— beans 17 

Mountain— grass 

House — roof 

Black— bath 10 

Mutton— butcher 

Comfort — cigar 17 

Hand— shoes 19 

Short— baseball 19 

Fruit — orange 

Butterfly— elephant 19 

Smooth — glass 

Command— general 

Chair— kitchen 17 

Sweet — cake 17 

Whistle— bird 

Woman — door 19 

Cold— ice 

Slow— cat 19 

Wish— bed 19 

River— trout 17 

White — paint 

Beautiful — monkey 19 

Window — bars 

Rough— rowdy 

Citizen— policeman 

Foot— fine 9 

Spider — insect 



Needle — sewing 

Red— man 9 

Sleep) — pond 19 

Anger — hatred 

Carpet — tacks 

Girl— floor 13 

High — mountain 

Working — dog 19 

Sour— milk 

Earth— mud 

Trouble — radiator 19 

Soldier — cannon 

Cabbage — vegetable 

Hard — wood 

Eagle— quick 19 

Stomach— flesh 

Stem — pipe 

Lamp — bum 

Dream— thinking 1 

Yellow — mice 19 

Bread— baker 

Justice — equality 

Boy — young 

Light— green 17 

Health— art 19 

Bible — ^preacher 

Memory — return 19 

Sheep — ^fold 

Bath — water 

Cottage — house 

Swift— fleeting 2 

Blue — dark 

Hungry — thirst 

Priest- elephant 15 



Ocean — briny Ifl 

Head — hard 

Stove— black 

liong— grass 

Religion — thinking 1 

Whiskey — Kentucky .... 

Child — carriage 

Bitter — pickles 

Hammer — naila 

Thirsty— wanting 

City— New York 

Square — base 17 

Butter — cow 

Doctor — carriage 

Loud— hall 19 

Thief— prison 

Lion — cage 

Joy — automobile 

Bed — iron 

Heavy— lead 

Tobacco — weed 

Baby— rocker 

Moon — sky 

Scissors — laundry ..... .19 

Quiet— peaceful 

Green — engine 19 

Salt — grocer 19 

Street— Lincoln 17 

King — Spain 

Cheese — baker 19 

Blossom — flower 

Afraid — going 2 



INVOLUTIONAL MELANCHOLIA; ALCOHOLIC DEMENTIA; SENILE 

DEMENTIA. 

There are so few cases of these psychoses in our series that we 
can say but little concerning their associational disorders. 

In Table V. we show all the types of reactions given by each 
subject. 

We have not observed in our cases of involutional melancholia 
any undue tendency to give individual reactions. The records 
are either perfectly normal or slightly abnormal in that they show 
an increase of the non-specific (common) reactions. In this 
respect they resemble strongly the records obtained from some 
cases of manic-depressive insanity. This similarity is of interest 
in connection with other evidence, recently brought to Hght,' show- 
ing that involutional melancholia is closely related to manic-de- 
pressive insanity, if not identical with it. 



* G. L. Dreyfus. Die Melancholie ein Zustandsbild des manisch-de- 
pressiven Irreseins. 1907. 



I9IO] 



GRACE HELEN KENT AND A. J. ROSANOFF 



361 



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362 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Case No. 4818.— S. M. 

Table — wood 

Dark — black 

Music — noise 

Sickness — illness 

Man— being 

Deep — depth 

Soft — mushy 

Eating — devouring 

Mountain — hill 

House — residence 

Black — color 

Mutton — meat 

Comfort— luxury 

Hand — body 

Short— abnipt 19 

Fruit — oranges 

Butterfly— insect 

Smooth — even 

Command — order 

Chair — article 1 

Bweet — taste 

Whistle — noise 

Woman— sex 

Cold— temperature 

Slow— dull 

Wish — desire 

River — water 

White — color 

Beautiful— sky 

Window — glass 

Rough — uneven 

Citizen — representative ..17 

Foot— end 19 

Spider— insect 

Case No. 6207.— T. S. 

Table — furniture 

Dark — color 

Music— fiddle 

Sickness — bed 

Man — person 1 

Deep — water 

Soft— pliable 

Eating— cake 

Mountain— high 

House — bricks 

Black — color 

Mutton — meat 

Comfort — easy 

Hand— limb 

Short— small 1 

Fruit — vegetable 

Butterfly— insect 

Smooth — level 

Command — control 

Chair — sit 

Sweet— nice 1 

Whistle — noise 

Woman — person 1 

Cold — atmosphere 

Slow — easy 

Wish — something 

River— stream 

White — color 

Beautiful— nice 1 

Window— glass 

Rough — unpleasant 1 

Citizen— person 1 

Foot— limb 

Spider — insect 



Normal record. 

Needle — instrument .... 

Red— color 

Sleep — repose 

Anger — temper 

Carpet— rug 

Girl— sex 

High — elevation 

Working — employment . . 

Sour — bitter 

Earth — clay 

Trouble — anxiety 

Soldier— military 

Cabbage — vegetable .... 

Hard— substance 

Eagle — ^bird 

Stomach — body 

Stem— flower 

Lamp — light 

Dream— imagination 

Yellow — color 

Bread — wheat 

Justice — credit 17 

Boy — child 

Light — sun 

Health — condition 

Bible — book 

Memory — remembrance . . 

Sheep— lamb 

Bath— ^bathing 

Cottage — house 

Swift — rapid 

Blue — color 

Hungry — desire 

Priest— minister 



Ocean— water 

Head — body 

Stove— fire 

Long — distance 

Religion — creed 

Whiskey— liquor 

Child— infant 

Bitter— sour 

Hammer — tool 

Thirsty— dry 

City — town 

Square — block 

Butter— food 

Doctor — physician 

Loud — noisy 

Thief— burglar 

Lion — animal 

Joy— happiness 1 

Bed— cot 

Heavy— weight 

Tobacco — weed 

Baby— infant 

Moon— light 

Scissors — instrument .... 

Quiet — noiseless 

Green — color 

Salt — seasoning 

Street— block 

King — ruler 

Cheese — food 

Blossom— flower 

Afraid— fear 



No individual reactions; 13 non-specific reactions. 



Needle — instrument 

Red — color 

Sleep — bed 

Anger — irritable ,-. 

Carpet — rug 

Girl — person 1 

High — elevation 

Working — try 2 

Sour — bitter 

Earth — sand 

Trouble — anxiety 

Soldier — person 1 

Cabbage — plant 

Hard — stone 

Eagle — bird 

Stomach — person 1 

Stem — apple 

Lamp— light 

Dream — sleep 

Yellow — color 

Bread — flour 

Justice — equal 

Boy — child 

Light — gas 

Health — doctor 

Bible— Scripture 

Memory — thought 1 

Sheep — animal 

Bath— water 

Cottage — house 

Swift — quick 

Blue — colpr 

Hungry — want 

Priest— preach 



Ocean — water 

Head— pereon 1 

Stove — heat 

Long — length 

Religion— belief 

Whiskey — drink 

Child— person 1 

Bitter — sour 

Hammer— tool 

Thirsty — dry 

City— place 

Square — shape 

Butter — eat 

Doctor — physician 

Loud — hear 

Thief— steal 

Lion — animal 

Joy— glad 

Bed — sleep 

Heavy— weight 

Tobacco — plant 

Baby — child 

Moon— light 

Scissors — tool 

Quiet— rest 

Green— color 

Salt — spice 

Street— place 

King— ruler 

Cheese — eat 

Blossom — flower 

Afraid — hide 



I9IO] 



GR.\CE HELEN KENT AND A. J. ROSANOFF 



3*53 



Case No. 5719. — A. W. S. 5 individual reactions; 12 non-specific re- 
actions. 



Table— Btand 

Dark — color 

Music — happy 1 

Sickneas — ill 

Man— human 

Deep — thought 1 

Soft— touch 

Eating — appetite 

Mountain — ground 

House — shelter 

Black — color 

Mutton — lamb 

Comfort— wann 

Hand — touch 

Short — small 1 

Fruit — taste 

Butterfly— beauty 1 

Smooth — level 

Command — obey 

Chair — rest 

Sweet— good 

>pVhistle — noise 

Woman — female 

Cold— chilled 2 

Slow — move 

Wish— think 1 

River — water 

White — color 

Beautiful — nice 1 

Window— glass 

Rough — push 

Citizen— man 1 

Foot — body 

Spider — insect 



Needle — pointed 

Red— blood 

Sleep — rest 

Anger— riled 

Carpet— covering 

Girl— child 

High — air 

Working — ambitious .... 

Sour — taste 

Earth— ground 

Trouble — thought 1 

Soldier — command .... 

Cabbage — vegetable 

Hard— blow 17 

Eagle — bird 

Stomach— body 

Stem— pipe 

Lamp — light 

Dream — thought 1 

Yellow — purple 

Bread— food 

Justice — law 

Boy — male 

Light — lamp 

Health— soul 19 

Bible — Scriptures 

Memorj-— thought 1 

Sheep — lamb 

Bath — cleanness 

Cottage — house 

Swift — quick 

Blue — color 

Hungry- appetite 

Priest — scholar 2 



Ocean — water 

Head — brains 

Stove — heat 

Long— measurement 2 

Religion— good 1 

Whiskey — alcohol 

Child— baby 

Bitter — taste 

Hammer — knock 

Thirstv — water 

City— New York 

Square — box 

Butter— milk 

Doctor — help 

Loud — noise 

Thief— burglar 

Lion — animal 

Joy— well 19 

Bed — rest 

Heavy— load 

Tobacco — nicotine 

Baby— joy 

Moon — light 

Scissors — cutting 

Quiet — rest 

Green — color 

Salt— sand 19 

Street — crossing 2 

Ring — ruler 

Cheese — luxury 19 

Blossom — flower 

Afraid— fright 



Case No. 5635. J. D. 13 individual reactions, of which 6 are classed as 
normal, i particle, 6 unclassified, mostly obviously normal. 



Table — eating 

Dark — night 

Music — amusement 

Sickness — distress 

Man— working 

Deep — sorrow 

Soft — easy 

Eating — supper 17 

Mountain— pleasure 1 

House — home 

Black— grief 19 

Mutton— butchers 2 

Comfort — home 

Hand — shake 

Short— baseball 19 

Fruit — eating 

Butterfly— field 

Smooth— soft 

Command — oblige 17 

Chair — seat 

Sweet — flowers 

Whistle-fire 

Woman— home 

Cold — winter 

Slow — easy 

Wish- home 

River — dock 17 

White — day 

Beautiful — handsome . . . 

Window — glass 

Rough — wagon 19 

Citizen — voter 

Foot — walking 

Spider— web 



Needle — sticking 19 

Red — danger 

Sleep — rest 

Anger — right 19 

Carpet— house 

Girl- out 12 

High — air 

Working — labor 

Sour— bitter 

Earth — ground 

Trouble — worry 

Soldier — man 1 

Cabbage — fanner 2 

Hard— bath 19 

Eagle — birds 

Stomach — body 

Stem — pipe 

Lamp — bum 

Dream — thinking 1 

Yellow — color 

Bread — eating 

Justice — peace 

Boy— soldier 17 

Light — day 

Health— happy 1 

Bible — books 

Memory — good 1 

Sheep — lamb 

Bath— washing 

Cottage — house 

Swift — quick 

Blue — color 

Hungr>' — eating 

Priest — church 



Ocean—bathing 

Head — mind 

Stove — fire 

Long — hours 

Religion — church 

Whiskey — drinking 

Child— home 

Bitter — sour 

Hatamer— working 

Thirsty — dry 

City— New York 

Square — block 

Butter— cow 

Doctor— hospital 

Loud — speaking 2 

Thief— sentence 17 

Lion — animal 

Joy — pleasure 1 

Bed — sleeping 

Heavy— weight 

Tobacco — smoking 

Baby— home 

Moon— night 

Scissors — cutting 

Quiet— alone 

Green— color 

Salt^ — eating 

Street — walking 

King— William 17 

Cheese — milk 

Blossom — flower 

Afraid— fright 



Our cases of alcoholic dementia are clinically without evidences 
of disturbance of flow of thought. The dementia consists mainly 



364 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



in impairment or loss of the power of retention, with resulting 
amnesia for recent occurrences, and temporal disorientation. The 
records are either normal or show but slight departures from 
normal. 



Case No. 6369. — J. S. 

Table— eat 

Dark— night 

Music — enjoyment 

Sickness — sadness 

Man— work 1 

Deep — hole 

Soft — feathers 

Eating— appetite 

Mountain — hill 

House — live 

Black— dark 

Mutton — eat 

Comfort — pleasant 1 

Hand— work 1 

Short — story 

Fruit — eat 

Butterfly— annoyance ... 6 

Smooth — iron 

Command — officer 

Chair— flit 

Sweet — nice 1 

Whistle — pleasure 1 

Woman — pleasure 1 

Cold— annoyance 6 

Slow — car 

Wish — like 

River — water 

White— sack 17 

Beautiful— house 17 

Window — look 

Rough — unpleasant 1 

Citizen— man 1 

Foot — walk 

Spider — annoyance 

Case No. 6418.— J. R. 

Table — mahogany 

Dark— dawn 17 

Music — harp 17 

Sickness — none 6 

Man — white 19 

Deep — unfathomable ... 2 

Soft— silken 2 

Eating— good 1 

Mountain— high 

House — place 

Black — color 

Mutton — cooked 17 

Comfort — rest 

Hand — clasp 19 

Short- small 1 

Fruit— apples 

Butterfly— buttercups ... 2 

Smooth— iron 

Command— home 19 

Chair— ebony 19 

Sweet — potatoes 17 

AVTiifltle — song 

Woman— pretty 1 

Cold — depressed 19 

Slow — process 17 

Wish — home 

River — Mississippi 

White — wings 17 

Beautiful- palace 19 

Window — clear 

Rough— no 12 

Citizen — patriot 

Foot— heath 19 

Spider — none 6 



Slight deterioration. 

Needle — sticking 19 

Red — color 

Sleep — happy 1 

Anger — annoyance 

Carpet — walk 

Girl — school 

High — skies 

Working— labor 

Sour — lemon 

Earth — walk 

Trouble — annoyance 

Soldier — army 

Cabbage — eat 

Hard — stone 

Eagle— fly 

Stomach— victuals 17 

Stem— pipe 

Lamp — burn 

Dream — sleep 

Yellow — orange 

Bread — eat 

Justice — peraon 1 

Boy — school 

Light — see 

Health— comfort 

Bible — read 

Memory — recollection . . . 

Sheep — eat 

Bath — cleanness 

Cot tage — live 

Swift — go 

Blue — color 

Hungry — eat 

Priest — confession 

Marked deterioration. 

Needle — darning 

Red— apples 

Sleep — plenty 

Anger — mistake 17 

Carpet— floor 

Girl — pretty 1 

High — ordinary 19 

Working— eight 12 

Sour — nonsense 19 

Earth— fruits 2 

Trouble— little 

Soldier — patriot 

Cabbage — garden 

Hard — wood 

Eagle — high 

Stomach- leave 19 

Stem— stalk 

Lamp — kerosene 

Dream — happy 1 

Yellow — aster 17 

Bread — white 

Justice — right 

Boy — white 15 

Light — white 

Health— good 1 

Bible— puzzled 19 

Memory — bad 1 

Sheep — cheviot 17 

Bath— marble 17 

Cottagt'— story 17 

Swift— fast 

Blue — waist 17 

Hungry — not 2 

Priest— confessor 



Ocean— vessels 2 

Head— knowledge 

Stove — bum 

Long — time 

Religion— faith 

Whiskev — drink 

Child— infant 

Bitter — unkind 17 

Hammer — nail 

Thirsty — dry 

City — inhabitants 

Square — brick 

Butter— eat 

Doctor — cure 

Loud — noise 

Thief— steal 

Lion — animal 

Joy— happiness 1 

Bed— lay 

Heavy — feeling 2 

Tobacco — chew 

Baby — nurse 

Moon — bright 

Scissors — cut 

Quiet— ease 

Green — flower 

Salt— taste 

Street — walking 

King — control 19 

Cheese — eat 

Blossom — flower 

Afraid — nervousness .... 



Ocean— Pacific 17 

Head— oval 19 

Stove — polish 

Long — forever 12 

Religion— Protestant . . . 

Whiskey — none 

Child — none 5 

Bitter — sweet 

Hammer — no 12 

Thirsty— no 5 

City — New York 

Square — compass 

Butter— sweet 

Doctor — cure 

Loud — quietly 2 

Thief— jail 

Lion — brave 

Joy — peacefulness 2 

Bed — good 1 

Heavy — no 

Tobacco — yes 12 

Baby — none 6 

Moon — shines 

Scissors — uncut 2 

Quiet— peaceful 

Green — grass 

Salt — water 

Street— Queen 17 

King— unknown 19 

Cheese— Stilton 17 

Blossom — cherry 

Afraid— not 



I9IO] 



GRACE HELEN KENT AND A, J. ROSANOFF 



365 



We reproduce in full the record obtained from one of our cases 
of senile dementia. 



Case No. 5788.— E. S. 

Table — cat 6 

Dark— night 

Music — cat 2 

Sickness — cat 5 

Man — mouse 18 

Deep — well 

Soft— sack 19 

Eating — well 

Mountain— hill 

House — castle 

Black— dog 

Mutton — sheep 

Comfort— lamb 13 

Hand — chicken 18 

Short— light 19 

Fruit — apple 

Butterfly— fly 

Smooth — iron 

Command — obey 

Chair- stool 

Sweet — sugar 

Whistle— lump 18 

Woman — man 1 

Cold — shiver 

Slow— cold 7 

Wish— push 19 

River— pond 

White— cat 

Beautiful — cat 5 

Window — glass 

Rough— tight 19 

Citizen— tough 

Foot — shoe 

Spider — clock 19 



Needle — pin 

Red — white 

Sleep— eyes 

Anger — mad 

Carpet — cloth 

Girl— boy 

High — low 

Working — sewing 

Sour — sweet 

Earth — clay 

Trouble— cold 15 

Soldier— man 1 

Cabbage — spinach 

Hard— cat 6 

Eagle — bird 

Stomach— belly 

Stem— pike 17 

Lamp — globe 

Dream — eyes 

Yellow — flower 

Bread — flour 

Justice — right 

Boy — cat 6 

Light — lamp 

Health— cough 17 

Bible— book 

Memory — mind 

Sheep — lamb 

Bath — water 

Cottage — house 

Swift— quick 

Blue — color 

Hungry — eat 

Priest — clergyman 



Ocean— river 

Head— life 

Stove— fire 

Long— short 

Religion — Catholic 

Whiskev — drink 

Child— boy 

Bitter — sweet 

Hammer — noise 

Thirsty— drink 

City— New York 

Square — Marion 17 

Butter — cow 

Doctor— W 17 

Loud — noise 

Thief— steals 

Lion — beast 

Joy— happy 1 

Bed— mattress 

Heavy — load 

Tobacco — smoke 

Baby— boy 

Moon — shine 

Scissors — cut 

Quiet — noisy 

Green — color 

Sialt- bitter 

Street- place 

King — rule 

Cheese — taste 

Blossom — flower 

Afraid — trouble 



§ 8. Pathological Reactions from Normal Subjects. 

Mental disorders do not always so manifest themselves as to 
incapacitate the subject for his work or to necessitate his seques- 
tration in a hospital for the insane. It is, therefore, not sur- 
prising that in applying the association test to over a thousand 
subjects selected at random we have obtained a small number of 
test records which show various types of abnormal reactions. 
Among the subjects who furnished such records some are de- 
scribed as eccentric, taciturn, or dull, while others are apparently 
normal but come of neuropathic stock. A few of them are per- 
sons wholly unknown to us. 

We reproduce in full several records from the normal series, 
containing abnormal reactions. 



366 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



CoNSEcuTiv'E No. 746. — State hospital attendant. Efficient in his work 
but is generally regarded to have married very foolishly. Sound reactions; 
numerous unclassified reactions. 



Table — brought 19 

Dark — some 19 

Music— leaf 19 

Sickness — water 19 

Man — book 19 

Deep — desk 19 

Soft — ground 

Eating— bark 19 

Mountain — tree 

House — paper 19 

Black— light 

Mutton— horse 13 

Comfort— hat 19 

Hand— €ick 13 

Short — swallow 19 

Fruit — mass 19 

Butterfly— leaf 15 

Smooth— wing 13 

Command— man 1 

Chair— left 19 

Sweet — sick 2 

Whistle— whirl 10 

Woman — where 12 

Cold— coal 

Slow — some 15 

Wish— whirl 15 

River — rice 19 

White — waist 

Beautiful — brought 15 

Window — women 10 

Rough — row 19 

Citizen — sir 10 

Foot— fall 19 

Spidei^spice 10 



Needle — knee 10 

Red — roam 19 

Sleep — sorrow 19 

Anger— August 19 

Carpet — covered 2 

Girl— great 9 

High— his 12 

Working— map 19 

Sour — slur 10 

Earth- eat 19 

Trouble— through 12 

Soldier— solder 10 

Cabbage — cart 19 

Hard— him 12 

Eagle—earth 13 

Stomach— stall 10 

Stem— stair 10 

Lamp— left 19 

Dream — dread 

Yellow — waist 15 

Bread— book 15 

Justice — gem 19 

Bov— bird 19 

Light— left 10 

Health— heart 17 

Bihl^base 19 

Memory — moth 19 

Sheep— shrill 19 

Bath— bend 19 

Cottage — cart 20 

Swift— swell 10 

Blue— beard 11 

Hungry- heart 15 

Priest— path 19 



Ocean — oar 10 

Head— him 12 

Stove— still 10 

Ixjng— left 15 

Religion — rest 19 

Whiskey— whirl 15 

Child— charge 19 

Bitter— bought 10 

Hammer— hemp 10 

Thirsty— Thursday 10 

City— salt 10 

Square — squirrel 10 

Butter — bread 

Doctor — daisy 19 

Loud— lark 19 

Thief— twist 19 

Lion — lesson 10 

Joy— jar 19 

Bed— beard 10 

Heavy— health 10 

Tobacco — toboggan 10 

Baby— bird 15 

Moon — mill 19 

Scissors — setters 10 

Quiet — quart 10 

Green — great 9 

Salt — sorrow 10 

Street— stem 10 

King — cart 15 

Cheese — chart 19 

Blossom — bed 19 

Afraid— frill 10 



Consecutive No. 220. — Laundryman in State hospital. Nothing abnormal 
has ever been observed in his case. Numerous perseverations. 



Table — house 

Dark— range 19 

Music — cats 

Sickness — dog 18 

Man — baxn 19 

Deep — hollow 

Soft — apple 

Eating — cranberry 17 

Mountain — water 17 

House — pig 19 

Black— rats 18 

Mutton— mice 2 

Comfort— sheep 13 

Hand— lamb 14 

Short— birds 19 

Fruit — peach 

Butterfly— pears 18 

Smooth— grapes 18 

Command — nut 18 

Chair— bureau 

Sweet — broom 19 

Whistle— violin 19 

Woman— man 1 

Cold— child 10 

Slow— infant 14 

Wish— night 19 

River— dark 14 

White — steamboat 17 

Beautiful— tugboat 18 

Window—yacht 18 

Rough— ferry 18 

Citizen — water 13 

Foot — egg 19 

Spider— fly 



Needle — thread 

Red— spool 18 

Sleep — machine IS 

A nger— picture 19 

Carpet— bed 17 

Girl— bureau 18 

High— oilcloth 18 

Working— pen 19 

Sour — ink 18 

Earth — paper 18 

Trouble- chair 19 

Soldier— table 14 

Cabbage — beet 

Hard— cauliflower 13 

Eagle — potatoes 18 

Stomach — beans 17 

Stem— plum 17 

Lamp — wick 

Dream— oil 13 

Yellow — stick 19 

Bread — stone 18 

Justice— dirt IS 

Boy — street 

Light— match 

Health— sickness 

Bible — book 

Memory — leaf 13 

Sheep — wool 

Bath— water 

Cottage — people 1 

Swift— fast 

Blue — residence 19 

Hungry — beef 17 

Priest — clergyman 



Ocean— rice 19 

Head — eyes 

Stove — ncse 18 

Long — mouth 18 

Religion— legs 18 

Whiskey — arms 18 

Child— elbows 18 

Bitter— day 19 

Hammer — nails 

Thirsty — saw 13 

City— plane 18 

Square — chisel 18 

Butter— file 18 

Doctor — duck 10 

Loud — goose IS 

Thief— robber 

Lion — tiger 

Joy— bear 13 

Bed— leopard 18 

Heavy — tiger 15 

Tobacco — smoke 

Baby— pipe 13 

Moon — star 

Scissors — sharp 

Quiet— noisy 

Green— blue 

Salt— yellow 13 

Street — green 14 

King— purple 14 

Cheese — axe 19 

Blossom — handle 19 

Afraid— bam 19 



igio] 



GRACE HELEN KENT AND A. J. ROSANOFF 



367 



Consecutive No. 255. — State hospital attendant, 
taciturn and secliisive. Sound reactions. 



Table — linen 

Dark — sunshine 17 

Music — song 

Sickness — Saturday 19 

Man — manager 10 

Deep — dark 

Soft— sorrowful 10 

Eating— eighty 10 

Mountain — miner 19 

House— heart 19 

Black— blue 

Mutton — mountain 10 

Comfort— company 17 

Hand— happy 10 

Short— slow 17 

Fruit- froth 10 

Butterfly— butter 10 

Smooth — smoke 10 

Command — company . . . 

Chair— chap 10 

Sweet — slow 15 

Whistle— whip 10 

Woman — worried 19 

Cold— cow 10 

Slow— slap 10 

Wish — water 

River— rubbed 19 

White — wash 

Beautiful— bounty 10 

Window — light 

Rough— roguish 19 

Citizen— sight •seeing ... 19 

Foot— fool 10 

Spider — span 10 



Needle — work 1 

Red— robe 19 

Sleep — soap 10 

Anger— angel 19 

Carpet — carriage 19 

Girl—guide 19 

High— heart 10 

Working— worthy 10 

Sour — satchel 19 

Earth — early .....lO 

Trouble— trout 19 

Soldier — socket 19 

Cabbage — currant 17 

Hard— harmful 10 

Eagle — early 15 

Stomach — stable 19 

Stem—stand 10 

Lamp — light 

Dream — drunk 10 

Yellow— lustre 19 

Bread — brand 10 

Justice — judgment 

Boy — butter 15 

Light— love 19 

Health— help 10 

Bible— book 

Memory— mental 

Sheep — shop 10 

Bath— bandage 10 

Cottage— cot 10 

Swift — swan 10 

Blue-black 10 

Hungry— height 19 

Priest — house 



Efficient, but unusually 



Ocean— apple 19 

Head— heart 

Stove — strap 10 

Long— love 15 

Religion — belief 

Whiskev— whisk broom. .10 

Child— chap 10 

Bitter— butter 10 

Hammer— habit 19 

Thirsty— thirty 10 

City— soap 15 

Square — squirrel 10 

Butter— bank 19 

Doctor — dentist 

Loud — laugh 

Thief— thump 19 

Lion— lump 19 

Joy — jump 19 

Bed— bank 15 

Heavy— happy 10 

Tobacco — tub 19 

Baby — bundle 

Moon— mantle 10 

Scissors — Saturday 15 

Quiet — quarter 10 

Green— drought 19 

Salt— Saturday 10 

Street— straight 

King— cattle 19 

Cheese — captain 19 

Blossom— bandage 15 

Afraid— flattered 10 



Consecutive No. 442. — Nothing abnormal has ever been suspected in 
the case of this subject; mother eccentric; sister insane. Sound reactions. 



Table— stable 

Dark^^lreary 

Music — joy 

Sickness — silliness 10 

Man — manner 10 

Deep— dreary 15 

Soft— eooth 19 

Eating — evening 10 

Mountain— morning IS 

House — help 19 

Black— darlc 

Mutton — mitten 10 

Comfort — come 10 

Hand— handsome 10 

Short — small 1 

Fruit— first 10 

Butterfly— butter 10 

Smooth— sooth 10 

Command — come 

Chair— air 10 

Sweet — good 1 

Whistle — music 

Woman — wonder 19 

Cold — freezing 

Slow — snow 10 

Wish— wind 10 

River^riffle 3 

White— wait 10 

Beautiful — handsome . . . 

Window — light 

Rough- harsh 

Citizen — city 

Foot— walk 

Spider — creep 



.10 



.10 



.10 
.19 



Needle — needless . , 

Red — color 

Sleep — sleet 

Anger — rough — 
Carpet — carpenter 

Girl — going , 

High— air 

Working — toiling 

Sour — shower 10 

Elarth- eating 19 

Trouble — loneliness 17 

Soldier— solid 10 

Cabbage — carrying 19 

Hard- hardly 8 

Eagle — eating 10 

Stomach — starch 10 

Stem — step 2 

Lamp — glass 

Dream— dreary 

Yellow — yonder 12 

Bread— bed 10 

Justice — juice 10 

Boy— ball 

Light— likeness 10 

Health— help 10 

Bible— book 

Me nior>'— memorial 2 

Sheep — sleep 

Bath— battle 10 

Cottage — cotton 10 

Swift— fast 

Blu^-blind 10 

Hungr>- — hurry 10 

Priest— prince 10 



Ocean — over 12 

Head — large 1 

Stove — stone 10 

Long— heavy 19 

Religion — goodness 1 

Whiskey — strong 

Child— small 1 

Bitter— butter 10 

Hammer— hard 

Thirsty— thrifty 10 

City — seeing 10 

Square — squirrel 10 

Butter— bitter 10 

Doctor — dark 10 

Loud — noisy 

Thief — stealing 

Lion — eating 

Joy— joyous 8 

Bed — sleep 

Heavy— weightful 4 

Tobacco — cocoa 10 

Baby— boys 2 

Moon — moo 3 

Scissors — successors 10 

Quiet — easy 

Green — grass 

Salt — simmer 19 

Street— steep 10 

King— kingdom 

Cheese — squeeze 10 

Blossom— blooming 

Afraid — Africa 10 



368 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Consecutive No. 314. — School teacher. Efficient; described' as very 
silent. Unclassified reactions, due mostly to distraction. 



Table— cat 19 

Dark— no 12 

Music— will 19 

Sickness — chair 19 

Man— table 6 

Deep— floor 14 

Soft — paper 6 

Eating — wood 19 

Mountain — chair 15 

House— window 

lilack — wall 

Mutton— sky 10 

Comfort— air 18 

Hand — table 

Short— paper 6 

Fruit- sweeping 19 

But terfly— room 18 

Smooth — working 2 

Command — stone 19 

Chair— machine 19 

Sweet — radiator 19 

Whistle— clock 19 

Woman — cane 19 

Cold— flower 19 

Slow— cord 19 

Wish — marriage 2. 

River— chimney 19 

White— wheel 19 

Beautiful— cane 15 

Window— pot 19 

Rough— grass 19 

Citizen — paper 

Foot— closet 19 

Spider— awning 19 



Needle — good 9 

Red— bad 9 

Sleep — hinge 19 

Anger— will 15 

Carpet— paper 6 

Girl- chair 15 

High— table 6 

Working— cane 15 

Sour — floor 15 

Earth — ceiling 18 

Trouble — chain 19 

Soldier— desk 19 

Cabbage— paper 

Hard— table 

Eagle — flower 15 

Stomach— match 19 

Stem— match 

Lamp — table 

Dream — chair 14 

Yellow — cane 18 

Bread— flour 

Justice — peace 

Boy — window 15 

Light— wall 18 

Health— floor IS 

Bible — house 18 

Memory — paper 6 

Sheep— dress 19 

Bath— clothes 18 

Cottage— earth 19 

Swift— skv 18 

Blue— trees 19 

Hungry — leaves 18 

Priest— bark 18 



Ocean — boat 

Head— hat 

Stove — ashes 17 

lyong- short 

Religion— peace 

Whiskey — bottle 

Child— dress 

Bitter — sour 

Hammer — teeth 19 

Thirsty— dry 

City — good 1 

Square— wood 

Butter— best 10 

Doctor — shoes 19 

Loud— music 

Thief— notes 2 

Lion — strings 19 

Joy— happy 1 

Bed— wish 13 

Heavy— lead 

Tobacco — plant 

Baby — good 1 

Moon — paper 6 

Scissors — straw 19 

Quiet — hoop 19 

Green — rope 19 

Salt— dish 

Street— dirt 

King— bucket 19 

Cheese — plate 

Blossom— plant 

Afraid — sweeping 15 



Consecutive No. 216. — State hospital attendant. 
Numerous non-specific reactions. 



Incompetent, dull. 



Table— rolling 19 

Dark^swim 19 

Musi c — playing 

Sickness— riding 19 

Man— walk 

Deep— singing 19 

Soft— light 

Eating — sleep 

Mountain — low ..... , . . . 

House — small 1 

Black — dark 

Mutton— lean 19 

Comfort— good 1 

Hand— small 1 

Short— small 1 

Fruit- taste 

Butterfly— beautiful 1 

Smooth— long 6 

Command— immediate .. 2 

Chair — small 6 

Sweet— clear 19 

Whistle — long 

Woman — small 1 

Cold— long 6 

Slow— write 2 

Wish — quick 10 

River— long 

White — clean 

Beautiful— nice 1 

Window— big 19 

Rough — bad 1 

Citizen — short 19 

Foot— small 1 

Spider — small 1 



Needle — small 1 

Red^dark 

Sleep — easy 

Anger — bad 1 

Carpet — small 1 

Girl— short 15 

High— long 

Working — good 1 

Sour — bad 1 

Earth— large 1 

Trouble— bad 1 

Soldier— good 1 

Cabbage — small 6 

Hard — apples 

Eagle — small 6 

Stomach— good 1 

Stem — short 

Lamp — bright 

Dream— good 1 

Yellow — light 

Bread— good 1 

Justice — good 1 

Boy — small 1 

Light— clear 

Health— good 1 

Bible — true 

Memory— good 1 

Sheep— many 

Bath— good 1 

Cottage — large 1 

Swift — fast 

Blue — dark 

Hungry— long 6 

Priest— true 19 



Ocean — wide 

Head— large 1 

Stove — black 

Long— wide 

Religion — good 1 

"WTiiskey — strong 

Child— small 1 

Bitter— bad 1 

Hammer — small 1 

Thirstv— bad 1 

City— big 

Square — long 

Butter — good 1 

Doctor — good 1 

Loud — hearty 19 

Thief— bad 1 

Lion — bad 5 

Joy — happy 1 

Bed — easy 

Heavy — stone 

Tobacco — strong 

Baby — small 1 

Moon— large 1 

Scissors — sharp 

Quiet— baby 

Green — dark 

Salt— strong 10 

Street — wide 

King — high 

Cheese — good 1 

Blossom — apples 

Afraid— he 12 



igiol 



GRACE HELEN 



KENT AND A. J- ROSANOFF 



369 



CONSECUTIVE No. 3i8-School boy 

Necdle-eharp 
Table— board 
Dark— nig*"'. 
Music— 60""" 



Non-specific reactions. 



Sicitaeai-pleasantness .. 9 

Man— people 

Deep— river 2 

Soft- cat , 

Eating-pleaBantnesa ... 1 

Mountain— high 

House— home 

Black— dark ^ 

Mutton— good . 

Comfort-pleasure ^ 

Hand— foot 

Short— little ^ 

Fruit— good -. , 

Butterfly— pretty ^ 

Smooth— soft 

Command— go 

Chair — sit . ■ , 

Sweet— good 

Whistle— noise 

Woman— pretty 

Cnld— bad '■ 

Slow— quick , 

Wish— good 

River— deep 

White-snow , 

Beautiful— pretty ^ 

Window— look 

Bough— even , 

Citizen— good 

Foot— hand 

Spider— bite 



Bed— crimson 

Sleep— wake 

Anger— mad 

Carpet— floor ^ 

Girl— good 

High-tall •• 

Working— sleep ^ 

Sour — bad 

Earth— ground ^ 

Trouble— bad . 

Soldier— good g 

Cabbage— bad 

Hard— soft 

Eagle— bird 

Stomach— ache 

Stem— slender 

Lamp— light -^ 

Dream— good , 

Yellow— pretty ^ 

Bread— good . 

Justice— good ••• 

Bov— fun 

Light— see , 

Health— happiness ^ 

Bible— good ^ 

Memory— good ^ 

Sheep— pretty ^ 

Bath— good , 

Cottage— pretty 

Swift— quick ■• 

Blue— yellow 

Hungry— eat ^ 

Priest— good 



Ocean— big ,5 

Head-little 

Stove— hot 

Long— distance ^ 

Religion— good ^ 

Whiskey— bad 

Child— cute ^ 

Bitter— good 

Hammer— hard , 

Thirsty— hard g 

Citv— good 

Square— round 

Butter— soft , 

Doctor— good 

Loud— noisy g 

Thief— good 

Lion— big J 

Joy— good ...■■• 

Bed— comfortable 

Heavy— light ^ 

Tobacco— bad ., 

BabT— pretty „ 

Moon— cute 

Scissors— sharp 

Quiet— loud , 

Green— pretty ^ 

Salt— good 

Street— narrow ^ 

King— good ^ 

Cheese— good , 

Blossom— pretty 

Afraid— scared 



Q.hool bov Non-specific reactions. 
Consecutive No. 234--School boy 

Needl^-thick ^ 

Bed— cow 

Sleep— dreams j^ 

Anger— very , 

Carpet— pretty J 

Girl— small 

High— tree 

Working— hard 

Sour— bitter , 

Earth- great 

Trouble— hard 



.19 



Table— chair 

Dark— cold 

Music— sweet 

Sickness— hard ... 

Man— wise 

Deep— dark 

Soft- sweet ■■ 

Eating— drinking 

Mountain— snow ^ 

House— great 

Black— horse ^ 

Mutton— good 

Comfort— health 

Hand— foot 

Short— fat , 

Fruit— good •■ , 

Butterfly-pretty '■ 

Smooth— hard . . ■ 

Command— general 

Chair— soft , 

Sweet— good 

Whistle— loud 

Woman— large 

Cold— dreary 

Slow— hard 

Wish— fairy ^ 

River— large 

White— snow 

Beautiful— woman 1 

Window— large 

Rough— hard ^ 

Citizen— good ^ 

Foot— sm.ill 

Spider— ugly 



.19 



Soldier— brave .. 

Cabbage— good 

Hard— stone „ 

Eagle— great 

Stomach— weak 

Stem— watch . 

Lamp— pretty 

Dream— sweet 

Yellow— buttercup 

Bread— flour , 

Justice— man 

Boy— gun 

Light— bright „ 

Health— care - 

Bible— holy 

Jlemory— poor 

Sheep— pretty J 

Bath— nice 

Cottage— low 

Swift- stream 

Blue— bluebird ' 

Hungrv— tired 

Priest— church 



Ocean— water . 

Head— large 

Stove— fire 

Long— snake 

Religion— Jesus 

Whiikev-temperance .. 

Child-healthy 

Bitter— apple 

Hammer— nail 

Thirsty— water 

City — houses • " 

Square— desk 

Butter— yellow 

Doctor— medicine 

Loud— harsh 

Thief— wicked 

Lion— fierce , 

Jov— happiness 

Bed— rest 

Heavy — stone 

Tobacco— dirty , 

Baby— small 

Moon— sky 

Scissore— sharp 

Quiet— lonely 

Green— sour „ 

Salt— cows j 

Street— people ^^ 

King— rich 

Cheese — yellow 

Blossom— pretty 

Afraid— fear 



370 



A STUDY OF ASSOCIATION IN INSANITY 



[Oct. 



Consecutive No. 809. — Lawyer. 28 individual reactions, of which 14 are 
classed as normal; 10 are unclassified, most of which are also obviously 
normal. 



Table — chair 

Dark — candle 17 

Music — girl 

Sickness-— doctor 

Man — woman 1 

Deep— swimming 19 

Soft— hand 

Eating— Reisenweber . . .17 

Mountain— Kipling 19 

House — mortgage 17 

Black — spectrum 19 

Mutton— pig 

Comfort — chair 

Hand— ring 

Short— tall 

Fruit — banana 

Butterfly — color 

Smooth— sphere 17 

Command— soldier 

Chair — teacher 10 

Sweet— apple 

Whistle — policeman 

Woman — hat 

Cold— thermometer 19 

Slow — invalid 

Wish— million 

River- Hudson 

White— Broadway 19 

Beautiful— girl 

Window — school 

Rough— ball 19 

Citizen— justice 

Foot— shoe 

Spider— insect 



Needle— tailor 17 

Red — flannel 

Sleep- 
potassium bromide. .17 

An^er — teacher 

Carpet- tack 

Girl— belt 17 

High— pole 

Working— laborer 

Soiu-- apple 

Earth — Columbus 

Trouble — lawyer 19 

Soldier— gun 

Cabbage— plantation 2 

Hard — brick 

Eagle — feathers 

Stomach — juice 17 

Stem— leaf 

Lamp — light 

Dream— pillow 17 

Yellow—lemon 

Bread — crust 

Justice — judge 

Boy— pants 

Light— gas 

Health— medicine 

Bible— Jacob 17 

Memory — brain 

Sheep — wool 

Bath — soap 

Cottage— rod 19 

Swift— ball 

Blue — sky 

Hungry— I 



Priest— surplice 

Ocean — ship 

Head — hair 

Stove— shovel 17 

Long— pole 

Religion — Abraham 19 

Whiskey- Kentucky ... .17 

Child— baby 

Bitter— pepper 

Hammer — nail 

Thirsty— lemonade 

City— Manhattan 17 

Square — Washington 

Butter— salt 

Doctor — nurse 

Loud — hammer 

Til ief— jewelry 

Lion— Androcles 19 

Joy — automobile 

Bed— shoes 15 

Heavy— Flan nigan 19 

Tobacco— pipe 

Baby— wife 

Moon — man 1 

Scissors — cut 

Quiet — demure 

Green — eves 

Salt-cellar 

Street— Wall 17 

King— Edward 

Cheese — Roquefort 

Blossom— field 

Afraid— burglar 



§9. Number of Different Words Given as Reactions. 

It has been suggested by Fuhrmann' that the number of dif- 
ferent words given in response to one hundred selected stimulus 
words may be used as " a fairly reliable measure of the intel- 
ligence and degree of education of a patient." The test accord- 
ing to Fuhrmann is applied twice in every case, the interval be- 
tween the two sittings being at least four weeks. " In very 
intelligent and well educated persons every lOO stimulus words 
almost always evokes in the first test 95 — 100 different associa- 
tions ; in the less intelligent and in the feeble-minded the same 
associations are more frequently repeated. In the second test 
with the same stimulus words — which is really much more im- 
portant than the first, since even persons or inferior intelligence 
may reach higher numbers in the first test — the difference in the 
wealth of the stock of representations becomes plainly evident: 



* Diagnostik und Prognostik der Geisteskrankheiten, p. 93. Leipzig, 1903. 



igio] GRACE HELEN KENT AND A. J. ROSANOFF 37I 

the man of intelligence will not need to draw on the associations 
which he gave in the first test, but will produce new ones ; the 
feeble-minded subject will, on the contrary, repeat to a greater or 
lesser extent the associations of the first test." " In general the 
associational capacity of an adult person may be taken to be from 
80 per cent to 90 per cent. Should the number sink below 70 per 
cent the suspicion of a pathological condition must then arise ; 
and the higher the subject's degree of education the stronger is 
this suspicion. In the case of an associational capacity of 60 per 
cent or less no doubt of its pathological significance can remain 
any longer." 

Our results are not strictly comparable with Fuhrmann's, be- 
cause we have obtained but one test record from each subject; it 
may be said, however, that the results of a single test in each case 
do not show any considerable differences, correspo